January-February 2002

NEWSLETTERNewsletter of the Society for Academic Emergency Medicine January/February 2002 Volume XIIII, Number 1

PRESIDENT’S MESSAGE

Projecting SAEM 2010SAEM has had a rich and fruitful his-

tory. It was my great fortune to be amember of the University Association ofEmergency Medicine (UAEM) and theSociety for Teachers of EmergencyMedicine (STEM). These organizationswere the forerunners of SAEM and theCouncil of Emergency MedicineResidency Directors (CORD). FromSAEM’s beginning as an organization in1989 to now I have witnessed marvelous

progress.The SAEM family has grown with increased membership,

diversity, and Annual Meeting attendance. We have developedoutstanding regional and Annual Meetings and we have pursuedour mission of improving patient care through advancing educa-tion and research very strongly. We have accomplished muchincluding development of our own journal (hardcopy and on-line),purchase of a building headquartered in Michigan, multiple grantsfor fellowships, sabbaticals and other awards including nationalrecognition through the Council of Academic Societies. How oftendo we as individuals look back at something that we have doneand then "beat ourselves up" because we should have done it adifferent way. My wife is always saying to me that I "beat myselfup" because I "could have", "should have" or "would have" donesomething in a different way but I didn’t. I am constantly remind-ing myself to go forward and not backwards and use events of thepast as a lesson but not as a hindrance for progress. I say this notto infer that SAEM should have done something differently in thepast but this statement is made to encourage us to review wherewe have been (i.e., what have we accomplished with 5 year goalsand annual objectives, etc.). It is easy to recap SAEM’s history bylooking back at the many accomplishments. But in this messageI am writing about the future.

Projecting SAEM into the year 2010 is a Board initiative devel-oped during my president-elect year with the work planned to takeplace during my presidential term.

What will SAEM look like by the year 2010? I am not a futuristbut it is important to plan for the future. Just as we set aside retire-ment funds, kids' college funds and various nest eggs and trusts,so should we plan the future for SAEM. What will be our commu-nications, financial, staffing, and building needs? How do weimprove upon our mission? How do we compare with other organ-izations? Do we know or should we even care about 2010? Myanswer is yes. We should care and we should project for thefuture. We should look at what our projected membership num-bers, publications and meetings needs will be. "Our country is

Marcus Martin, MD

Want A Second Opinion?Call for Your Non-Funded

Grant Application(s)Jeff Kline, MDSAEM Research Committee

The Research Committee has implemented a reviewprocess to provide peer-review of grant applications thathave been submitted and were not funded. We are seek-ing applications that have already been submitted andreviewed by a federal agency, a private or non-profit organ-ization or a foundation that issues grants. The purpose ofthis forum is to constructively evaluate the application in alimited public forum and to give feedback to the applicantabout how the grant application could be strengthened.The intention for the atmosphere to be informal and sup-portive. A panel of three reviewers who have reasonablyextensive experience in the grant-review process will pre-review a 2-page written summary and at the conferencewill hear a five to ten-minute oral presentation of the grant.The panel will then give feedback about how the applica-tion could be strengthened. The feedback will focus onhow the hypothesis and specific aims can be clarified,sharpened and focused for increased impact and chanceof success. The feedback process will include dialoguebetween the applicant and the review panel. The reviewcritique will be summarized in written form and forwardedto the applicant.

The Research Committee wishes to initiate this forumat the 2002 Annual Meeting. The forum will occur on theevening of May 20 (tentative). It will be open only to theapplicant and the reviewers and take approximately 90minutes. During that time, we plan to evaluate two or threegrant applications. We are seeking to have a two-pagesubmission which can be essentially a cut-and-paste of apreviously submitted grant that contains the following infor-mation:

� title and the authors with their affiliations � abstract of the work, � hypothesis, � specific aims,� short summary of previous criticisms by other extra-

mural reviewing committees, and� if necessary, a one-paragraph synopsis of any meth-

ods or statistical methods that warrant explanation inview of the comments of prior review.

� names of agencies that have previously reviewed theapplication.

The two-page application should be sent electronicallyto [email protected]. The deadline for receipt of applica-tions is April 15, 2002. For questions, contact Jeff Kline [email protected].

(continued on page 24)

SAEM NEWSLETTER

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[email protected]

www.saem.org

Emergency Medicine Training, Competency and Professional PracticePrinciples Position Statement

The concept for this position statement was discussed during a meeting of the ACEP and SAEM officers in mid-October. It wasagreed that Marcus Martin, Robert Schafermeyer, and Don Yealy would develop the position statement and that it would beoffered to all organizations for consideration. A draft was submitted to the organizations and input was solicited. A revised posi-tion statement, based on the input received from the organizations was sent and by November 30 all of the listed organizationshad endorsed it. This position statement will be published in the April issue of AEM and may be published in other journals.

Emergency Medicine is recognized as a specialty by theAmerican Board of Medical Specialties and the AmericanOsteopathic Association. Responsibilities of specialty statusinclude accrediting graduate medical education training pro-grams and credentialing physicians as certified specialists.These responsibilities require creating standards for compe-tency and defining professional practice principles.

Emergency physicians provide care and make treatmentdecisions based on real time evaluation of patients’ history,physical findings and many diagnostic studies, including theinterpretation of electrocardiographs, imaging studies and lab-oratory tests. Emergency physicians possess a wide range ofskills to treat injuries and illnesses and perform many inter-ventions including but not limited to resuscitative proceduresand trauma stabilization in patients of all ages.

It is the combined role and responsibility of the specialtyorganizations and the accrediting and certifying bodies inemergency medicine to set and approve the training stan-dards, assess competency through board certificationprocesses and establish the professional practice principles foremergency physicians.Endorsed by:American Academy of Emergency MedicineAmerican College of Emergency PhysiciansAssociation of Academic Chairs of Emergency MedicineCouncil of Emergency Medicine Residency DirectorsSociety for Academic Emergency Medicine

Medical Student Interest Group Grant Recipients AnnouncedJohn Duldner, MDSAEM Grants CommitteeAkron General Medical Center

SAEM is pleased to announce therecipients of the medical student inter-est group grants. Eighteen applicationswere received and reviewed by mem-bers of the Undergraduate EducationCommittee and coordinated by theGrants Committee. Each grant will befunded in the amount of $500 dollars.The Board of Directors approved thefunding for the following recipients:

Louisiana State University – CoreyJ. Pitre, Class of 2002 and faculty advi-sor, Peter DeBlieux, MD, have planneda series of clinical workshops with a"nuts and bolts" application to emer-gency medicine. They are expandingupon previous success with student-taught courses using case-based sce-narios and complementing these experi-ences with teaching labs and hands-onexposure to clinical aspects of emer-gency medicine.

Wake Forest University – Kim LeeAskew and faculty advisor, David E.Manthey, MD, have developed an inno-vative educational program that hascoordinated integration into the medicalschool curriculum. Using an organ sys-tem-based curriculum, clinical presenta-tions related to each organ system willbe presented by emergency physicianswhile incorporating the basic scienceand clinical aspects of the emergencypatient.

University of Colorado – AlisonSheets, Class of 2004 and faculty advi-sor, Kerry Broderick, MD, have planneda series of lectures to be incorporatedwithin the first year curriculum usingimaging studies including radiographs,ultrasound and MRI to correlate with theclassroom topics. In addition, a libraryof images will be made availablethrough the student group’s website aswell as on compact disc.

University of Connecticut – Jill Ripperand faculty advisor Thomas Regan, MD,submitted an educational workshop pro-posal that expands the strengths of theirestablished Emergency MedicineInterest Group. In addition to work-shops on suturing, airway and centralvenous access, a unique lumbar punc-ture workshop has been added utilizingspecial manikins.

The medical student interest groupgrants were developed to recognize andassist in development of medical stu-dent interest groups for medical stu-dents interested in a career in emer-gency medicine. The applications focuson educational activities or projectsrelated to undergraduate education inemergency medicine and the funds maybe used for supplies, consultation andseed money to support activities suchas skills laboratories, lectures or work-shops.

Start Thinking About the Annual Meeting!May 19-22, 2002 • Adams Mark Hotel • St. Louis, Missouri

Check the SAEM web site for details.

May 18 (pre-day)CPC Semi-Final Competition

Chief Resident ForumMedical Student Forum

Association of AcademicChairs of Emergency

Medicine (AACEM) MeetingAEM Consensus

Conference: AssuringQuality

May 19Papers/Posters/Exhibits

Plenary Session

May 20 Papers/Posters/Exhibits

CORD MeetingCORD New ProgramDirectors’ Workshop

Banquet


AEM Reviewers WorkshopCORD Board of Directors


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Jonathan A. Handler, MDNorthwestern University

I was pleased to see this month'spublication of the first article I havereviewed for AEM, and I wanted to com-ment on the website. I think it isextremely well done and quite seam-less.

When I clicked on the article linkfrom my AEM Table of Contents auto-email, I was taken to the abstract andpleased to see that the system hadstored a cookie on my system so that Iwas instantly recognized on arrival.That meant I was not forced to do anannoying login to read the full text of thearticle. That made for a very smoothand positive experience.

I like the design of the site, particu-larly the "Small Caps" font of the head-ings (e.g. "Methods"). The frequentlydispersed navigation boxes would seemwasteful of space were I to have consid-ered implementing it for a site, but inactual practice I think it really works welland is unobtrusive and well-placed. Thespeed of display is excellent.

The main site navigation is not splitbetween navigation both at the top andon the left side, which many sites do,and which I think is confusing. Rather, itall occurs at one place (the top), whichis good. In addition, the organization ofthe navigation links at the top, with site-specific links on the top line and user-

specific links on the next line immedi-ately adjacent to my name, is very clearand very clean. Frankly, I am a bit jeal-ous of its simplicity and effectiveness.

I am pleased to see that we haveimplemented a lot of the utilities I founduseful and cool at the BMJ site, such asdownloads to citation managers andalerts when this article is cited. I wasmost stunned to see that I can accessthe full text of articles cited in the refer-ences section. As I think about it, Ibelieve we talked about that at the edi-torial board meeting, but I forgot aboutthat and it is extremely positive that ithas been implemented. I think it wouldbe great if there was a note letting usersknow that the full text was made avail-able by AEM to these articles. I wasn'tsure when I clicked on the "Full Text"links whether or not I would be forced tosign in to that journal and be allowed inonly if I were a subscriber to it. I tried itanyway and it worked, but it wasn't clearthat I would not need a separate login tothe outside journal. Given that this issuch a great resource, I would "adver-tise" it a bit at the top of the referencessection in some way.

Anyway, I just wanted to let you knowthat I think this is an incredibly cool andwell done site. I would offer advice andsuggestions, but unfortunately right nowI have none because the things I wouldhave suggested have already beendone.

Letter to the Editor: www.aemj.org[Editor’s comment: This letter was addressed to James Adams, MD, SeniorAssociate Editor for Academic Emergency Medicine, and has been reformatted forthe Newsletter.]

CPC CompetitionSubmissions SoughtSubmissions are now being accept-

ed from Emergency Medicine residencyprograms for the 2002 Semi-Final CPCCompetition to be held May 18, the daybefore the SAEM Annual Meeting in St.Louis. The deadline for submission ofcases is February 1, 2002 and there isan entry fee of $200. Case submissionand presentation guidelines are on theCORD website at www.cordem.org.

Residents participate as case pre-senters, and programs are encouragedto select junior residents who will still bein the program at the time of the FinalsCompetition. Each participating pro-gram selects a faculty member who willserve as discussant for another pro-gram’s case. The discussant willreceive the case approximately 4-5weeks in advance of the competition.All cases are blinded as to final diagno-sis and outcome. Resident presentersprovide this information after completionof the discussants presentation.

The CPC Competition will be limitedto 50 cases selected from the submis-sions. A Best Presenter and BestDiscussant will be selected from each ofthe five tracks. The Best Presenter andBest Discussant recipients will receive acertificate and $250.

Winners of the semi-final competi-tion will be invited to participate in theCPC Finals to be held during the ACEPScientific Assembly in October inSeattle. A Best Presenter and BestDiscussant will be selected. Both willreceive a statue and $500.

The CPC Competition is sponsoredby ACEP, CORD, EMRA, and SAEM. Ifyou have any questions, please contactCORD at [email protected], 517-485-5484, or via fax at 517-485-0801.

SAEM Position Statement on Filming of Emergency Patients

The following position statement was approved by the SAEM Board of Directors onOctober 14, 2001 and will be published in the March 2002 issue of AEM. It will beaccompanied by a manuscript developed by the Ethics Committee, chaired byCatherine Marco, MD.

Patients seeking emergency care arevulnerable to intrusions of their privacyand confidentiality. Commercial filmingincludes all recording of images used forany purpose other than continuousquality improvement or education ofmedical personnel. Such activitiesafford no direct benefit to the involvedpatient. Individuals filming can hinderthe care, privacy and confidentiality ofemergency patients, and may bedisruptive to the healthcare providers.For these reasons, SAEM makes thefollowing recommendations.

Image recording by commercial

entities does not provide benefit to thepatient and should not occur in eitherthe prehospital or EmergencyDepartment setting. Re-enactment ofthe care process using skilled actors oreven the patient at a time remote fromthe actual emergency provides a viablealternative for education of the lay publicor for marketing purposes.

Image recording should undergo adual consent process. The firstaddresses privacy issues associatedwith the actual recording of the image.The second addresses confidentialityissues associated with distribution and

use of those images. The consentprocess should mirror those for otheractions or procedures in the EmergencyDepartment.

Image recording for qualityimprovement or education of medicalpersonnel associated with theworkplace is acceptable if the dualconsent process is maintained. Imagesobtained for medical education shouldundergo full disclosure to the patient ifthey are to be utilized in endeavorsbeyond the training institution, or forcommercial purposes such as textbooksor paid didactic sessions.

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Board of Directors UpdateThe SAEM Board of Directors meets

each month, usually by conference call.However, in person meetings are held inMay during the Annual Meeting, in the fallat either the ACEP Scientific Assembly orthe AAMC Annual Meeting, and in thewinter, usually in conjunction with anSAEM Regional Meeting or the CORDNavigating the Academic WatersConference. This article will highlight theBoard’s activities during the period ofSeptember through November, 2001.

The next Board meeting will be heldon March 3 during the CORD Navigatingthe Academic Waters Conference andthe CORD Best Practices Conference inWashington, DC. All SAEM membersare invited to attend the SAEM Boardmeetings.

The Board decided not to endorse thedocument “Clinical CompetenceStatement on Electrocardiography andAmbulatory Electrocardiography” thatwas developed by the American Collegeof Cardiology and the American HeartAssociation. A letter outlining the Board’sconcerns with the document was sent tothe American College of Cardiology andpublished in the September/October2001 issue of the SAEM Newsletter. Inaddition, the Board developed a letter tothe editor that was submitted to theJournal of the American College ofCardiology. The letter was not acceptedfor publication and was revised and sub-mitted to Academic Emergency Medicine(AEM). The Board asked William Brady,MD, and Edward Michelson, MD, to writea commentary that was submitted toAEM. Lastly, during an officers meetingbetween ACEP and SAEM in mid-October, it was agreed that MarcusMartin, MD, Robert Schafermeyer, MD,and Don Yealy, MD, would draft a positionstatement entitled, “Training,Competency, and Clinical PracticePrinciples” (published in this Newsletter).The position statement was subsequent-ly endorsed by the Association ofAcademic Chairs of EmergencyMedicine (AACEM), the AmericanAcademy of Emergency Medicine(AAEM), the American College ofEmergency Physicians (ACEP), theCouncil of Emergency MedicineResidency Directors (CORD), andSAEM. The position statement, letter tothe editor, and manuscript will be pub-lished in the April issue of AcademicEmergency Medicine.

The Board agreed that a major initia-tive of the Society was the developmentof the Research Endowment. RogerLewis, MD, PhD, Marcus Martin, MD,Susan Stern, MD, Don Yealy, MD, andBrian Zink, MD, will serve as a Boardworking group to develop a vision state-

ment, principles, descriptions and fund-ing goals for the Research Endowment.The working group is expected to reportto the Board before the end of 2001. TheBoard agreed that SAEM will require theassistance of a professional fund raiserto develop the Fund and allow SAEM tocontinue to expand the number of grantsthat are funded each year.

The Board developed and approved aposition statement entitled, “Filming ofEmergency Patients” (published in thisNewsletter). In addition, the Boardapproved a manuscript on the topic thatwas developed by the Ethics Committee.The manuscript and the position state-ment are expected to be published in theMarch issue of AEM.

The Board provided comments todraft guidelines developed by theAssociation for the Accreditation ofHuman Research protection. The Boardapproved a letter written by the NationalAffairs Task Force that was sent toCongress (and published in theNovember/December issue of the SAEMNewsletter) commenting on the MedicareEducation and Regulatory Fairness Act.

The Board agreed to provide repre-sentation to the EMS Errors ReductionConference sponsored by the NationalHighway Transportation SafetyAdministration. The Board asked thePatient Safety Task Force to recommenda representative to attend theConference. Dr. Douglas Kleiner, PhD,University of Florida, Jacksonville repre-sented SAEM at the conference and areport will be distributed to the Board andpublished in the next issue of theNewsletter.

The Board approved Linda Spillane,MD, University of Rochester, to serve aschair of the Consulting Service TaskForce, upon the resignation of LouisBinder, MD, who has been appointed tothe Residency Review Committee. TheBoard elected Glenn Hamilton, MD, toserve as the Board member on theNominating Committee.

The Board approved increasingactive dues to $365 and associate duesto $350 per year. The Board agreed notto increase resident, fellow, and medicalstudent dues. Details regarding the duesincrease were published in theNovember/December 2001 issue of theNewsletter.

The Board approved the appointmentof Robert Neumar, MD, to serve as oneof two SAEM representatives to theEmergency Medicine Foundation. Dr.Neumar and Dr. Yealy will representSAEM at the twice a year EMF Board ofTrustees meetings.

The Board approved the proposalfrom the National Affairs Task Force,

developed by Jim Hoekstra, MD, to con-vene educational sessions at the AAMCAnnual Meeting on November 4 inWashington, DC. The Association ofAcademic Chairs of EmergencyMedicine also convened a meeting at theAAMC Annual Meeting.

The Board approved the applicationssubmitted for the 2002 Western,Southeastern, New England, and Mid-Atlantic Regional Meetings.Advertisements for the regional meetingsin the SAEM Newsletter and AcademicEmergency Medicine have been provid-ed by SAEM.

The Board approved a request fromthe American Board of EmergencyMedicine to amend the ABEM Bylaws toexpand the number of members of theABEM Nominating Committee.

The Board approved the NationalHospital Ambulatory Medical CareSurvey and sent a letter of support. Inresponse to a request for informationfrom the National Heart, Lung, and BloodInstitute the SAEM Board requested andsubsequently approved the developmentof a response. That response was pub-lished in this Newsletter.

The Board accepted ACEP’s invita-tion to participate in the ACEP RuralWorkforce Task Force. Dr. Marcus Martinattended the inaugural meeting inOctober and Janet Williams, MD, WestVirginia University, has been appointedto represent SAEM on the Task Force.

The Board approved a slate of nomi-nees for submission to the AmericanBoard of Emergency Medicine for con-sideration of election. ABEM will beelecting two new ABEM directors.

The Board approved funding to sup-port Dr. Carlos Camargo, chair of theSAEM Public Health Task Force, toattend a Healthy People 2010 confer-ence. A report on the conference waspublished in the November/Decemberissue of the Newsletter.

The Board approved a policy that out-lines the responsibilities of SAEM repre-sentatives to other organizations.The policy will be posted on the SAEMweb site.

The Board discussed the status andprogress of the committees, task forces,and interest groups. Board members areassigned to serve as liaisons to eachcommittee, task force, and interest group.

The Board approved minor revisionsto the Journal Operational Guidelines.The Board approved the posting of PDFversions of the SAEM Newsletter on theweb site. The Board approved final ver-sions of the Research Training Grant andthe Institutional Training Grant applica-tions.

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Report of the First Contact, First Response: Ensuring Physician Readiness Conference

Hernan F. Gomez, MDUniversity of Michigan

It was my pleasure and honor tohave served as the EmergencyMedicine representative for SAEM andACEP for the AAMC conference, "FirstContact, First Response EnsuringPhysician Readiness for Biological,Radiation and Chemical Terrorism"which took place November 28, 2001.As may be discerned by the title of theconference – representation in this con-ference was clearly in our area of inter-est.The meeting may be summarized asfollows:Partial List of Participants

Jordan J. Cohen, MD, President,AAMC, Edward Baker, Jr., MD, MPH,Director, Public Health Practice Programoffice, CDC, Mohammad Akhter, MD,MPH, Executive director, American pub-lic Health Association, Colonel WilliamDuncan, MD, Chairman, Department ofMedicine, Walter Reed Army MedicalCenter, Michael Goldberg, PhD,Executive Director, American Society forMicrobiology, David B. Hoyt, MD, FACS,Chair, Committee on Trauma, AmericanCollege of Surgeons, Scott Lillibridge,MD, Special Assistant for NationalSecurity and Bioterrorism, Office ofSecretary Thompson, Department ofHealth and Human Services, StephenH. Miller, MD, Executive Vice President,American Board of Medical Specialties,Frances M. Murphy, MD, PhD, DeputyUnder Secretary for Health VeteransHealth Administration, Robert

Perelman, MD, Director, Department ofEducation, American Academy ofPediatrics, Thomas R. Russell, MD,FACS, Executive Director AmericanCollege of Surgeons, BarbaraSchneidman, MD, PPH, Interim VicePresident, Medical Education, AmericanMedical Association, Susan Scrimshaw,PhD, Dean, School of Public Health,University of Illinois at Chicago,Harrison Spencer, MD, MPH, Presidentand CEO, Association of Schools ofPublic Health, Douglas L. Wood, DO,PhD, President American Association ofColleges of Osteopathic Medicine,Michael Whitcomb, MD, Senior VicePresident, Division of MedicalEducation, AAMC. In addition, SenatorWilliam Frist, U.S. Senator (Tennessee)was present during the primary portionof the meeting.Meeting Summary

The meeting began with introductoryremarks by Dr. Cohen & Dr. Whitcomb,of the AAMC. The leaders of AAMCremarked that as representatives of thiscountry’s 125 medical schools and 400teaching hospitals, the AAMC believes akey priority is to prepare tomorrow’sdoctors with the information and tools torespond immediately and effectively toterrorist attacks. It was expressed thatmore needs to be done to be preparedto deal with terrorist attacks caused bybiological agents, or chemical and radi-ation exposure. The AAMC is in theprocess of building on a cooperativeagreement with the Centers for Disease

Control and Prevention. It is clear thatAAMC will be working closely with theCDC’s expert staff on an ongoing basisto identify ways to better prepare thephysician workforce with bioterrorism.

Senator Frist arrived during theopening remarks by the leadership ofAAMC and asked for support from themedical community of the Frist,Kennedy Bipartisan BioterrorismResponse Bill. This bipartisan legislationwas introduced to greatly strengthenAmerica’s preparedness and responseto bioterrorist attacks. The bill builds onthe efforts of last year’s "Public HealthThreats and Emergencies Act of 2000,"which was authored by Frist andKennedy and signed into law lastNovember. Senator Frist stated that,"The best way to protect Americansfrom these threats is to enhance ourpreparedness at the national, state andlocal levels." The "BioterrorismPreparedness Act of 2001" is designedto address existing gaps in our nation’sbiodefense and surveillance system, aswell as our public health infrastructure.It authorizes approximately $3.2 billionin fiscal year 2002 and includes theadministration’s priorities. The bill focus-es on four critical areas: providing feder-al assistance to state and local govern-ments in the event of a biological attack;improving public health, hospital, labora-tory, communications and emergencyresponse preparedness and respon-siveness at the state and local levels;increasing incentives for the rapid devel-

News from the Emergency Medicine FoundationDonald M. Yealy, MDSAEM Board of DirectorsUniversity of PittsburghRobert Neumar, MDUniversity of Pennsylvania

On October 15, 2001 at the ACEPScientific Assembly in Chicago, theEMF Board of Trustees met. Dr. MichaelRapp currently serves as Chair of theFoundation, with Robert Schaefermeyerserving as Chair-Elect. The EMF mis-sion, values, board members, grantapplications and awardees are availableonline (www.acep.org); these remainintact and serve to guide all decisions.

At this meeting, two new initiativeswere approved in addition to review ofthe previous fiscal cycle of revenues,expenses and grant awards. First, theEMF has decided to retain the service ofa professional fund raising consultant

organization to aid with delivering thefinancial resources needed to maintainand grow the programs. To date, EMFhas done well with both corporate andindividual contributions; however, theopportunity to enhance these streams isclearly present, and the partnership willaim toward this goal. Marijean Hall fromTripoints, Inc. will head these efforts,which will be closely monitored by EMFleadership. Because ACEP pays theadministrative expenses for EMF, theconsultant is actually retained by theCollege.

Secondly, a motion was made andapproved to increase the EMFFellowship Award from $35,000 to$75,000 for each funded year.Investigator/board members cited the need for funding that truly offset thecosts of such fellowships, and that this

funding amount was both commonlyoffered by various organizationsinvolved in training support and ade-quate in today’s academic environment.The EMF recognizes that increasedexpenditures require increased rev-enues, ‘dove-tailing’ this decision withthe previous initiative to enhance contri-butions. The goal is to draw the bestapplicants and then offer optimal sup-port, leading to a deeper pool of fundedemergency medicine investigators.

The EMF remains committed tofunding academic emergency physi-cians and related health care providers.SAEM offers support through joint spon-sorship of the Innovations in MedicalEducation and Medical Student Grants,and participation of two members (Drs.Robert Neumar and Donald M. Yealy).

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Is Your Project On This List?Clifton Callaway, MD, PhDSAEM Research CommitteeUniversity of Pittsburgh

This year, the SAEM ResearchCommittee undertook to identify investi-gators in emergency medicine who cur-rently receive NIH or other federal fund-ing. The long-term goal of generatingsuch a list is to provide the membershipwith a guide to the various experts with-in our specialty, and to help delineatewhat areas of expertise are available.

As a first step towards identifyingfederally funded investigators in emer-gency medicine, we conducted a searchof the NIH database of extramuralresearch support: CRISP (ComputerRetrieval of Information on ScientificProjects). This database can bereached through the NIH web page(www.nih.gov), and allows several

search strategies. The CRISP databasecontains principal investigator names,project titles, dates, study sections, andabstracts for all funded projects. UsingCRISP, a prospective investigator cansee what type of projects have receivedawards in the past and where in NIHthese projects were reviewed. In addi-tion, the database lists the departmentwithin each institution to which a grantwas awarded.

We encountered several problemswhile compiling this list. In particular, wefocused first on the Department field inthe search, hoping to capture all awardsfrom within a Department of EmergencyMedicine. Unfortunately, many awardslist another department in this field(such as when Emergency Medicine is aDivision of Medicine or Surgery), or insome cases the field was left blank alto-gether. Broadening our search to

include the word “emergency” in anyfield captured many more awards,including many that were clearly unre-lated to the specialty. In the end, we tookthe list from this latter search, andexamined all of the abstracts and princi-pal investigators to determine if the proj-ect was the work of an emergency med-icine investigator. In some cases weincluded projects where the investigatorhas appointment in another field, but thework was inseparable from the specialty(as in Dr. Hallstrom’s projects).

To supplement the results of theCRISP search, we received severalresponses to our advertisement in theNewsletter for information about federal-ly funded investigators. In addition, theResearch Committee had personalknowledge of several projects not other-

Principal Investigator Award Title Institution Award Number

Career Development GrantsBecker, Lance Metabolic inhibition of oxidant stress in reperfusion U Chicago 5K08 HL003459-05 Bunney, E.B. Electrophysiology of cocaine, ethanol and cocaethylene University of Illinois, Chicago 5K01 DA000285-05 Callaway, Clifton Brain ischemia and MAP kinase activation U Pittsburgh 5K02 NS002112-03 Klawitter, Paul Redox regulation of metabolism in hypoxic diaphragm Ohio State University 5F32 HL10216-02 Neumar, Robert Brain ischemia - Mu-calpain activation and eIF4e degradation U Penn 5K08 NS001832-06 Quinn, James A network of research sites to study clinical wound care UCSF 5K23 AR002137-02 Rothman, Richard ED guidelines for evaluation of febrile intravenous drug users The Johns Hopkins University 1K23 RR00052-395 S-1 VandenHoek, Terry Oxidants in myocardial preconditioning U Chicago 5K08 HL003779-04 Younger, John Lung injury, perfluorocarbons and hemorrhagic shock U Michigan 5K08 HL003817-02 Zink, Brian Alcohol and brain injury U Michigan 5K08 AA000184-05

Project GrantsBaraff, Larry Commercial telephone triage vs physician on-call advice UCLA-Harborview 3R01 HS010604-01S1 Brown, Michael Asthma surveillance and intervention in hospital EDs Michigan State CDC Camargo, Carlos Diet and chronic obstructive pulmonary disease Brigham and Women’s (Harvard) 5R01 HL063841-02 Chan, Ted Impact of oleoresin capsicum spray on respiratory function UCSD National Institute of Justice Crain, Ellen Improving EMS for children through outcomes research Columbia University 1R12 HS010942-01 D’Onofrio, Gail Emergency physicians’ brief intervention for alcohol Yale 1R01 AA012417-01A1 Eisenberg, Mickey Community Heart Action Project University of Washington 5U01 HL053141-05 Gorelick, Marc PEAT: pediatric emergency assessment tool Children’s Hospital of Wisconsin R03 HS11395-02 Green, Gary Coronary thrombosis and risk in the ED The Johns Hopkins University 1R01 HL069746-01 Hallstrom, Alfred Technology of CPR strategies: a randomized trial U Washington 5R01 HS008197-04 Hallstrom, Alfred Early access to defibrillation for vitims of OOH-CA U Washington 3N01 HC095177-001 Hallstrom, Alfred Clinical trial of an implantable cardiac defibrillator U Washington 3N01 HC025117-04 Hoffman, Stuart Effects of dihydroepiandrosterone on brain injury Emory University 1R03 HD040295 Kellerman, Arthur Progesterone treatment of blunt traumatic brain injury Emory University 1R01 NS39097 Krause, Gary Suppression of protein synthesis in reperfused brain Wayne State University 5R01 NS033196-06 Li, Gouhua Alcohol and general aviation The Johns Hopkins University 5R01 AA009963-08 Li, Gouhua Pilot aging and aviation safety The Johns Hopkins University 5R01 AG013642-05 Maitra, Subir GLU6PASE and 6P2K/FBASE gene regulation in sepsis SUNY, Stony Brook 5R01 GM058047 Neumar, Robert Calpain-mediated injury in post-ischemic neurons U Penn 5R01 NS039481-02 Olson, James Mechanisms of gene dysregulation in HD Wright State University 1R01 NS042157 Olson, James Mechanisms of cellular taurine transport in brain edema Wright State University 5R01 NS037485-03 Rothman, Richard Eval of febrile IV drug users guidelines for emer mgmt The Johns Hopkins University 2M01 RR00052 Stein, Donald Progesterone after traumatic brain injury Emory University 1R01 NS038664-01A2 Sullivan, Jonathon Cell survival in brain reperfusion Wayne State University 1R01 NS041919 Thom, Stephen Specialized center of research in hyperbaric oxygen therapy U Penn 5P50 AT000428-02 Thom, Stephen CO poisoning in the context of a reperfusion injury U Penn 5R01 ES005211-10 Yealy, Donald An empiric risk stratification rule for heart failure U Pittsburgh 1R01 HS010888-01

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Lynne Richardson, MD, Embarks on EMPATHRoland C. Merchant, MDSAEM Research CommitteeBrown University

The Robert Wood JohnsonFoundation recently granted $108,000to a new study that will examine accessto healthcare in U.S. emergency depart-ments. Lynne Richardson, MD, MountSinai School of Medicine EmergencyDepartment’s Vice-Chair and ResidencyDirector, will direct the EmergencyMedicine Patient’s Access to HealthCare (EMPATH) research project, whichwill attempt to categorize both the med-ical conditions and health care accessproblems that compel some patients toseek medical care from the ED.EMPATH is a pilot study that involves a24-hour snapshot of over 30 ED’sacross the United States. Dr.Richardson and her investigators willcollect data through patient interviewand ED record abstraction in late 2001and early 2002.

Through the EMPATH study, Dr.Richardson seeks the answer to twomain questions. (1) Why do patientsseek care from the ED instead of anoth-er health care facility? (2) For EDpatients, what medical conditions aresecondary to a lack of access to otherhealth care facilities and providers? Dr.Richardson believes the answer to thefirst question will be obvious for somepatients (e.g., compulsory EMS protocolfor trauma victims), but for others, thereasons may be more complicated.Primarily, though, it may be due to aninability to gain access to other forms ofhealth care. Such inabilities may

include no primary care provider, noopportunity or means of getting anappointment at another health caresource, a lack of insurance or funds foran insurance copayment, the inconven-ience of scheduled appointments or toolong of a delay until an appointment, etc.

As for the second question, Dr.Richardson believes that some ED visitscan serve as a marker for changes inhealth care access. She notes thatsome medical problems, such as diabet-ic ketoacidosis, severe asthma attacks,decompensated congestive heart fail-ure, may occur because of healthcareaccess problems. Dr. Richardson saysthe overall purpose of EMPATH is not toshow that health care access is a prob-lem, EMPATH is meant to serve as ameans to develop a tool to measureaccess to health care. For example,when a state changes its Medicaid eligi-bility requirements, patterns of ED uti-lization will likely be impacted. Dr.Richardson hopes to create an algo-rithm to monitor these patterns.

In the 1990s, an unfunded volunteer-based study looked at the problem ofhealthcare access and the turn to EDsfor primary care. EMPATH arose froman SAEM Public Health Task Forceobjective of examining access and uti-lization of EDs. In 1999, while a repre-sentative of the Public Health TaskForce, Dr. Richardson wrote a brief letterto the Robert Wood JohnsonFoundation, explaining the EMPATHconcept. After the foundation expressedinterest, Dr. Richardson followed her ini-tial letter with an expanded proposal,then a complete grant request when the

foundation solidified their support. Thegrant request process took about oneyear to complete. Dr. Richardson saidshe deliberately approached the RobertWood Johnson Foundation because oftheir demonstrated interest in healthcare access. She hopes EMPATH willserve as a pilot for an eventually feder-ally-funded larger study that will includemore United States Eds, as well as helpestablish a more definitive algorithm.

Dr. Richardson credits her researchendeavors to a serendipitous luncheonencounter. When serving as Chief ofEmergency Services at Harlem Hospitaland a Health Services Research fellowof the Association of American MedicalColleges in 1992, she met a representa-tive of the Agency for HealthcareResearch and Quality (AHRQ). TheAHRQ representative needed someonefamiliar with the ED to review a grantrequest from a cardiologist who wantedto perform an ED study. Her work on thatproject led to increasing involvementwith AHRQ in reviewing grants and later,an appointment to an AHRQ study sec-tion. Dr. Richardson says that shelearned a great deal about researchdesign, the funding process, and grants-manship from her work with AHRQ, andthat these experiences served her wellwhen she applied for the Robert WoodJohnson Foundation grant. Dr.Richardson believes that other EDresearchers can obtain funding likehers, and as a member of the AHRQHealthcare Research Training Section,she encourages more emergency physi-cians to investigate AHRQ grants tofacilitate their research and training.

Information Sought onFederally Funded

ProjectsIf you are a Principal or Co-

Investigator for a current program orproject grant supported by NIH, AHRQ,CDC or other federal funding, we inviteyou to notify the Research Committee ofyour project on an ongoing basis. TheResearch Committee activity will try topublicize new projects in EmergencyMedicine research to acknowledgesuccess in achieving funding, and to pointout resources for members seekingexpertise in particular fields. Sendinformation to Clifton Callaway, MD, PhDat [email protected].

Project List (Continued)wise listed. What results is a list of 37projects with an emergency medicine-based principal investigator. Of theseprojects, 10 are career developmentgrants. In addition, we became awareof a number of projects for which anemergency medicine investigator wasa co-investigator. Because the co-investigator role cannot be systemati-cally searched through public databas-es, we feel that our knowledge of co-investigators is too preliminary to bemeaningful. We have elected not toinclude those awards for this presenta-tion.

The lack of federal funding foremergency medicine research is anoften-heard complaint. However, the

breadth and diversity of research thatrelates to emergency medicine wouldprobably thwart any attempt to lump“EM research” into one bin. Supportingthis conclusion, the Table indicateshow funded investigators in our spe-cialty have focused projects, and drawsupport from the appropriate specificinstitutes within NIH. The ResearchCommittee hopes to continue high-lighting these projects, and to expandthis list to be more inclusive. If you areconducting, or are part of a project thatthis search missed, we apologize, andask that you please update theResearch Committee (c/o CliftonCallaway, University of Pittsburgh, [email protected]).

8

Academic AnnouncementsSAEM members are encouraged tosubmit Academic Announcements onpromotions, research funding, and otheritems of interest to the SAEM member-ship. Submissions should be sent [email protected] by March 1 for publi-cation in the March/April issue of theNewsletter.

Jean Abbott, MD, University ofColorado, Frank Counselman, MD,Eastern Virginia University, and PeterDeBlieux, MD, Louisiana StateUniversity, have been nominated by theOrganization of ResidentRepresentatives for the 2001 AAMCHumanism in Medicine Awards.Nominations were based on: positivementoring skills, collaboration, compas-sion/sensitivity, community serviceactivity, and observance of professionalethics. The award honors medicalschool faculty who embody the finestqualities in a healer who teaches heal-ing.

Clifton Callaway, MD, PhD, Universityof Pittsburgh, and Peter B. Richman,MD, Morristown Memorial Hospital,have been named OutstandingReviewers by Academic EmergencyMedicine. Dr. Callaway and Dr.Richman, as well as all AEM reviewersfrom July 2000 through July 2001, areacknowledged in the December issue of2001.

David Cone, MD, has been appointedto the position of Senior AssociateEditor of Academic EmergencyMedicine by Editor, Michelle Biros, MD.Dr. Cone is Associate Professor andChief, Division of EMS and EMSFellowship Director at Yale University.

At the University of Colorado, RichardDart, MD, has been promoted toProfessor of Surgery, BenjaminHonigman, MD, has been promoted toProfessor of Surgery, StevenLowenstein, MD, MPH, has been pro-moted to Professor of Surgery andMedicine, and Peter Pons, MD, hasbeen promoted to Professor of Surgery.All surgery promotions are in theDivision of Emergency Medicine. Inaddition, Dr. Lowenstein has beenappointed Associate Dean for FacultyAffairs at the School of Medicine.

Terry Kowalenko, MD, has beenselected as the emergency medicineresidency director at the University ofMichigan. Dr. Kowalenko previouslyserved as the residency director at theWayne State University/Sinai-GraceHospital program in Detroit.

Robert Neumar, MD, has been appoint-ed as one of two SAEM representativesto the Emergency Medicine Foundation.Dr. Neumar is an Assistant Professor of

Emergency Medicine at the Universityof Pennsylvania.

Steven A. Seifert, MD, has beenappointed Medical Director of thePoison Center at Children’s Hospital inOmaha, Nebraska. The Poison Centerat Children’s Hospital (along with theArizona Poison and Drug InformationCenter and the Rocky Mountain Poisonand Drug Center) was awarded a$375,000 DHHS/HRSA grant for a multi-center study of medical error in poisoncenter settings.

Rebecca Smith-Coggins, MD, hasbeen appointed to the ResidencyReview Committee for EmergencyMedicine. Dr. Smith-Coggins is theemergency medicine residency directorat Stanford University.

Vincent Verdile, MD, has been namedDean of Albany Medical College andExecutive Vice President for HealthAffairs at Albany Medical Center. Dr.Verdile has served as interim dean forthe past year.

In February 2002, Keith Wrenn, MD,will be awarded one of ten inauguralParker J. Palmer “Courage to Teach”awards by the Accreditation Council onGraduate Medical Education. Dr. Wrennis the emergency medicine residencyprogram director at VanderbiltUniversity.

Call for SubmissionsInnovations in Emergency Medicine Education Exhibits

2002 Annual MeetingDeadline: February 15, 2002

The Program Committee is accepting applications for review for the Innovations in Emergency Medicine Education(IEME) Exhibits at the 2002 SAEM Annual Meeting, May 19-22 in St. Louis. Submitters are invited to complete an applica-tion describing an innovative new educational methodology that they have designed, or an innovative educational applica-tion of an existing product. The exhibit should not be used to display a commercial product that is already available and beingused in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting.Commercial support of innovations is permitted but must be disclosed. IEME exhibits will not be published in AcademicEmergency Medicine with other abstracts, but will be listed in the on-site program. However, if submitters have conducteda research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scien-tific review in the appropriate subject category by the January 8 deadline.

The deadline for submission of IEME Exhibit applications is Tuesday, February 15, 2002 at 5:00 pm Eastern Time andwill be strictly enforced. Only electronic submission via email attachment to [email protected] will be accepted. The appli-cation form and instructions will be available on the SAEM web site at www.saem.org in November. For further informationor questions, contact SAEM at [email protected] or 517-485-5484 or via fax at 517-485-0801.

Society for Academic Emergency Medicine • 901 North Washington Avenue • Lansing, MI 48906

SAEM

9

Report on the AAMC Annual MeetingJim Hoekstra, MDChair, SAEM National Affairs Task Forceand Representative to CAS/AAMCOhio State University

On November 2-7, in Washington,DC, the Association of AmericanMedical Colleges held their annualmeeting. The topic of the meeting was"Facing the Future," with emphasisplaced on the present crisis in academ-ic medicine’s abilities to deal with thepressures of a growing and aging popu-lation, declining medical college appli-cant pools, shrinking resources, and therecent challenges of disaster medicineand bioterrorism. Jordan Cohen, presi-dent of the AAMC, addressed the par-ticipants and called for a renewedemphasis on humanism and profession-alism in medicine and medical educa-tion. George Sheldon, MD, referred tothe crisis in our emergency departmentsand called for an increase in medicalschool output to face the increasingdemand for medical care in this country.

In concordance with the AAMC’sagenda for the annual meeting, SAEMsponsored and organized an education-al program on "Preserving theEmergency Medicine Safety Net." Dr.Lynne Richardson from Mt. SinaiHospital (NYC) and Dr. Jim Gordon fromHarvard co-presented a synopsis of theAEM-sponsored consensus conferenceon the EM safety net that convened inMay, 2001. Dr. Richardson presentedthe emergency medicine view of theInstitute of Medicine Report on patientsafety, with emphasis on the report’srecommendations of continual monitor-ing and federal support of the medicalsafety net. The IOM report was aimedprimarily at primary care as the medicalsafety net, but it describes emergencymedicine is the "floor" which supportsthe primary care safety net. As such,emergency medicine is the "ultimatesafety net." Dr. Richardson eloquentlyoutlined the crisis in emergency medi-cine with staggering statistics onincreasing emergency department vis-its, increasing charity care, nursingshortages, increasing EMS diversion,and decreasing hospital bed availability.The consensus conference identifiedinput, system, and output problems asthe possible causes of ED overcrowd-ing. Of these three factors, the consen-sus was that output, with inability toeither admit patients to the hospital ordischarge patients to appropriate outpa-tient facilities, was by far the major con-

tributor to ED overcrowding. Dr. Gordonfollowed with a call for research into thecauses of ED overcrowding. He out-lined the need for more research intothe public health effects of the loss ofthe EM safety net. The EMPATH study,which seeks to identify the patient char-acteristics in overcrowded EDs, isamong the many safety net researchprojects sponsored by the AHRQ andother governmental agencies, which arecrucial to identifying the nature of EDovercrowding and ambulance diversion.In addition, Dr. Gordon challenged theacademic emergency medicine commu-nity to expand our research into safetynet care. We have administered tetanusshots as a public health initiative foryears. Why shouldn’t we expand ourinvolvement into preventive care, dis-ease risk factor analysis and interven-tion, alcohol and drug rehabilitationreferrals, vaccinations, and identificationof patients eligible for federal and stateaid programs? It’s obvious from both Dr.Richardson and Dr. Gordon’s presenta-tions that EM needs to take the lead inresearch and public advocacy issuessurrounding the medical safety net.Only EM can outline the problems thatneed to be addressed and recommendthe appropriate changes that will pre-serve the ultimate medical safety net.The program was well received, andattended by representatives of theAAMC.

The safety net program was followedby an AACEM-sponsored session onNIH funding opportunities. BelindaSeto, PhD presented the funding oppor-tunities available at the NIH, including allthe R and K awards, with emphasis onthe awards that were most applicable toEM. Statistics were presented regard-ing the percentage of awards grantedfor new versus established investiga-tors. The student loan payback programfor NIH sponsored investigators wasalso presented. The need for catego-rization of the awards given out to emer-gency medicine investigators, and theneed for an NIH study section for EM,were discussed at length. Emergencymedicine has begun to make inroadsinto NIH funded trials. At present, over$6 million in NIH and AHRQ dollars areawarded each year to emergency medi-cine investigators.

The AACEM educational programwas followed by a luncheon, co-spon-sored by SAEM and AACEM. TonyMazzaschi from the Council ofAcademic Societies and the AAMC was

the featured speaker. He outlined therelationship between the AAMC and theacademic societies, including SAEMand AACEM. He presented a number ofopportunities for interaction and influ-ence between SAEM and organizedacademic medicine. The AAMC hasbeen challenged to take a leadershiprole in the organization of educationalresponses to bioterrorism. It has part-nered with the CDC to begin to organizea "tool box" of educational materials onbioterrorism that can be used through-out the academic medical community.In addition, it is leading the efforts toorganize medical responses to disas-ters and bioterrorism. Its involvementwith organized emergency medicine willbe crucial to the success of these edu-cational and communications programs.AAMC values input from academicemergency medicine on issues that arecommon, both internally, as well as inthe political advocacy arena.

The AAMC meeting was a great suc-cess for emergency medicine. The pro-grams were well advertised, well organ-ized, and well attended. Emergencymedicine continues to grow in its visibil-ity and influence in the academic medi-cine community. Given our future chal-lenges, this growth is crucial to our suc-cess as a specialty.

More on the AAMC Meeting

David P. Sklar, MDSAEM Representative to CAS/AAMCUniversity of New Mexico

I attended the AAMC Annual Meetingas the other SAEM representative andadd a few a comments to Dr. Hoekstra’sexcellent report.

The meeting was overshadowed byevents in Afghanistan and the bio-terror-ism issues concerning anthrax.However, the various groups at themeeting focused on a few issues ofimportance.

The AAMC has decided to supportan 80-hour workweek for residents.Although this will not affect emergencymedicine residencies which already hadmandated less than 80 hours, it willaffect surgery, medicine, and thereforeindirectly all residents rotating on thoseservices. The surgeons in particularappear to be most distressed at the


10

Call for NominationsDeadline: February 1, 2002

Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awardswill be presented during the SAEM Annual Business Meeting in St. Louis. Nominations for honorary membership

for those who have made exceptional contributions to emergency medicine are also sought. The Nominating Committeewishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or anySAEM member. Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications.Nominations can be sent to [email protected] or 901 N. Washington Ave., Lansing, MI 48906. The awards and criteria aredescribed below:

SAEM • 901 N. Washington Ave., Lansing, MI 48906 • www.saem.org

SAEM

Academic Excellence AwardThe Hal Jayne Academic Excellence Award is presented toa member of SAEM who has made outstanding contribu-tions to emergency medicine through research, education,and scholarly accomplishments. Candidates will be evaluat-ed on their accomplishments in emergency medicine,including:1. Teaching

A. Didactic/BedsideB. Development of new techniques of instruction or

instructional materialsC. Scholarly worksD. PresentationsE. Recognition or awards by students, residents, or peers

2. Research and Scholarly AccomplishmentsA. Original research in peer-reviewed journals

B. Other research publications (e.g., review articles, bookchapters, editorials)

C. Research support generated through grants and con-tracts

D. Peer-reviewed research presentationsE. Honors and awards

Leadership AwardThe Leadership Award is presented to a member of SAEMwho has demonstrated exceptional leadership in academicemergency medicine. Candidates will be evaluated on theirleadership contributions including:1. Emergency medicine organizations and publications.2. Emergency medicine academic productivity.3. Growth of academic emergency medicine.

The Editors of Academic Emergency Medicineannounce the next AEM Consensus Conference on“Assuring Quality” to be held on May 18 in St. Louis. Theconference will aim to describe means of defining, assess-ing, measuring, and researching the delivery of qualityemergency care in the clinical setting. We believe the con-ference is a logical progression in our consensus series,which has included “Errors in Emergency Medicine,” and“The Unraveling Safety Net.” We therefore issue this call forpapers related to the topic of Assuring Quality. Submittedmanuscripts are due on March 1, 2002. Accepted paperswill be published in the late fall of 2002, along withProceedings from the consensus conference.

Please submit eligible papers to the AEM editorial officein Lansing at [email protected]. Electronic submission of theoriginal and a blinded copy are preferred. Submit also acover letter clearly indicating that your submission is for theAssuring Quality Consensus Conference. General instruc-tions for authors appear at www.saem.org/inform/journal.htm.

Any questions regarding this call for papers on the AEMConsensus Conference can be directed to Michelle Biros,MD, at [email protected] or Jim Adams, MD,at: [email protected].

AEM Call for Papers“Assuring Quality”

Nominations Requested forResident Member of the SAEM

Board of DirectorsNominations are sought for the resident member of

the SAEM Board of Directors.The resident Board mem-ber is elected to a one-year term and is a full votingmember of the Board. The deadline for nominations isFebruary 1, 2002.

Candidates must be a resident during the entire oneyear term on the Board (May 2002-May 2003) and be amember of SAEM. Candidates should demonstrate evi-dence of strong interest and commitment to academicemergency medicine. Nominations (preferably sent viae-mail) should include a letter of support from the can-didate’s residency director, as well as the candidate’sCV and a cover letter. Nominations should be sent [email protected] or 901 N. Washington Ave., Lansing,MI 48906. Candidates are encouraged to review theBoard of Directors orientation guidelines on the SAEMweb site at www.saem.org or from the SAEM office.

The election will be held via mail ballot in the Springof 2002 and the results will be announced during theAnnual Business Meeting in St. Louis.

The resident member of the Board will attend fourSAEM Board meetings; in the fall, in the winter, and inthe spring (at the 2002 and 2003 SAEM AnnualMeetings). The resident member will also participate inmonthly Board conference calls.

11

Medical Student Virtual Advisor Program Presented Felix Ankel MDSAEM Board of DirectorsRegions Hospital

SAEM's virtual advisor's program was presented at the26th annual Innovations in Medical Education exhibits inWashington DC, on November 4-6 during the AAMC AnnualMeeting. The Virtual Advisor program was developed by theSAEM Undergraduate Education Committee under the direc-tion of Wendy Coates, MD. It electronically pairs EM-interest-ed medical students with volunteer faculty advisors and pro-vides web based resources to them. The virtual advisor pro-gram serves over 200 students and 80 faculty since going "live'at the SAEM Annual Meeting in May 2001.

AAMC members, including deans of students and medicalstudent advisors familiarized themselves with SAEM and theVirtual Advisor program during the three day exhibit.Feedback was positive and many planned to distribute virtualadvisor information to their medical students. Others plannedto incorporate the general concepts of the virtual advisor pro-gram to develop local on-line advising and mentoring systems.The AAMC medical careers web page for EmergencyMedicine www.aamc.org/medcareers/specorgs/emermed.htmlhas a direct link to SAEM's virtual advisor home pagewww.saem.org/advisor/index.htm.

We anticipatean increased stu-dent participationwith AAMC meet-ing publicity.Please sign up asa virtual advisor atw w w. s a e m . o r g /a d v i s o r / a d v -app.htm to meetthis need.

An assessmentof the VirtualAdvisor program iscurrently underway.Both students andfaculty who were involved are being asked to evaluate the pro-gram and suggest ways to improve it. Results will be sharedwith SAEM members and the program modified as needed.Thanks to all of you have volunteered your time.

SAEM Medical Student Educators Interest Group Annual MeetingDavid Manthey, MDWake Forest UniversityDouglas Ander, MDEmory University

In an effort to better support medical student educators in theirendeavor to develop the best Emergency Medicine Rotation,the interest group will offer a 2-hour seminar. This seminar willconsist of a panel discussion showcasing various methods foreducating, evaluating, and grading medical students. It will befollowed by presentations on how to apply for monetary assis-tance and what resources are already available to make theprocess easier.

AGENDA:1) Educational Component ( 2 hours)

a) PANEL DISCUSSION AND QUESTION / ANSWERSESSIONi) Curriculum development

(1) Goals and Objectives(2) Lecture versus Case Series(3) Self-study Modules

ii) Evaluation and grading(1) How to evaluate successful completion of your

objectives(2) Standardized Grading(3) Test (National versus Individual)

b) PRESENTATIONSi) Budget issues

(1) What monies are needed(2) How to obtain money from the Medical Schoo/

Department

ii) Resources Available(1) Virtual Advisor(2) EMMSE Page(3) Innovative Educational Ideas

2) Business Meeting (1 hour)a) Review of last years activitiesb) Growth of web sitec) Ideas for next year’s educational program.d) Growth of the interest group.

The date and time of this meeting are to be determined. Thespeaker’s list will be forthcoming soon. Please feel free toaccess our site at http://www.saem.org/inform/emmse.htm formore information about this interest group and updated infor-mation on this meeting.

All interest groups are invited to submit theirproposed interest group meeting agendasfor publication in the March/April Newsletter.The deadline for receipt is February 15.Electronic submission to [email protected] preferred.

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CORD Best Practices Conference

Medicare Physician Payment Fairness Act SupportBelow is the text of a letter that was developed by the National Affairs Task Force. The letter was sent to U.S. Senators in lateNovember

The Society for AcademicEmergency Medicine (SAEM) repre-sents approximately 5500 academicemergency physicians practicing emer-gency medicine in academic medicalcenters and teaching hospitals through-out the U.S. SAEM welcomes theopportunity to lend our support to the“Medicare Physician Payment FairnessAct of 2001” (S.1707) that has beenintroduced by Senator Jim Jeffords andSenator John Breaux. The principlesset forth in this Act are essential toensure that the Emergency MedicineSafety Net remains viable in times oftrue crisis in our nation’s health caresystem.

Prior to the events of September 11,emergency departments had been sub-ject to a crisis of nation-wide overcrowd-ing (See Newsweek, September 10,2001). Emergency department visitscontinue to rise at a rate of approxi-mately one million visits per year. Anexpanding population, nursing short-ages, hospital closures, and an ever-increasing geriatric population have ledto a national shortage of hospital beds.The business model of financial incen-tives that favor admission of electivepatients over emergency admissionshave resulted in reduced inpatientcapacities for emergency patients andhave turned emergency departmentsinto extensions of inpatient and ICUwards. As a result, emergency depart-ments everywhere are filled beyondcapacity with admitted patients who arewaiting for inpatient beds. Ambulancesare asked to divert from one hospital toanother due to hospital and ED crowd-

ing. An ever-increasing uninsured pop-ulation continues to use the emergencydepartments as the primary source forall levels of care, adding to financialstrain. Managed care has made con-certed efforts to drive patients awayfrom the emergency department, butthese efforts have been ineffective. TheInstitute of Medicine Report on Errors inMedicine described the emergencydepartment as the “floor” upon whichthe medical safety net is built. This safe-ty net is in crisis.

Since the events of September 11,Emergency Medicine has been asked toincrease its role to combat bioterrorism.Emergency Medicine provides an inte-gral role in disaster planning and med-ical care during mass casualty events.Emergency departments have beenflooded with patients asking for testingfor anthrax. This is a time when the pub-lic is terrorized that they may have abioterrorist infection, and occupationhistory taking and careful review of flulike illness is essential to maintain thepublic trust. The people are turning totheir local emergency departments forcare. To date, we have been dealingwith anthrax, which is not communica-ble. Imagine the state of readiness thatwould be needed to combat a communi-cable disease such as small pox orplague, for which we are preparingtoday. Hazardous materials training,drills, equipment, and system organiza-tion are a top priority for emergencydepartments and EMS providers every-where. Emergency medicine organiza-tions provide input and resources in ournational response to terrorism. This we

have done gladly, but not without a pricein manpower and financial resources.

In the face of this crisis, the Centerfor Medicare and Medicaid Services hasreported that physician payments for the2002 year will be cut 5.4% across theboard. In addition, emergency medicinewill receive another 2.6% reduction dueto the final year phase-in of the practiceexpense methodology (a methodologywhich was flawed from the beginning,and which was opposed by emergencymedicine). This totals an 8% reductionin physician payments for Medicarepatients in 2002 compared with 2001.

In addition, the nation’s emergencydepartments must be staffed with highlytrained professionals who can meetfuture terrorist threats and at the sametime provide care to over 100 millionpatient visits per year. In the face of thiscrisis in our emergency departments,we feel the proposed reduction in pay-ments is unjustified and medically dan-gerous. Further reductions in Medicarepayments will be devastating and willhave serious effects on the viability ofour nation’s medical safety net. We askthat you support the “MedicarePhysician Payment Fairness Act (S.1707).” This bill will provide some relieffrom the proposed cuts in physician pay-ments by CMS. It would reduce theacross the board cuts from 5.4% to0.9%. It would also direct MEDPAC toreview the practice expense calculationmethodology that we believe is flawed.

SAEM thanks you for the opportunityto express our views. We welcome theopportunity to discuss this issue withyou at any time.

CORD is sponsoring a consensus conference, to be heldon March 2-3, 2002 in Washington, DC, to present and discuss"best practice" models in emergency medicine residency edu-cation. The conference will highlight models to incorporate thesix new ACGME core competencies into educational programsand will also explore "best practices" in other important areasof the emergency medicine residency curriculum. We willfocus particularly on topics related to resident evaluation andassessment. The conference will include general discussionsessions as well as small group breakout sessions. We haveinvited educational leaders from the ACGME and other aca-demic organizations to participate with us. We also plan topublish the results of the conference work in a special issue ofAcademic Emergency Medicine.

CORD is excited about the potential for emergency medi-cine, with this consensus conference, to provide a leadershiprole among the specialties in medicine in developing effectiveeducational models for resident competency. The success ofthis conference, however, depends largely on the contributionsof those in the academic emergency medicine community.

To that end, we invite members of CORD and SAEM to par-ticipate in this conference and to share your experience andideas about these important and timely issues. Please setaside these dates in your calendar to attend this importantconference. For more information contact CORD at [email protected]

13

Comments on the Development of a Resuscitation Research ConsortiumThe National Heart, Lung, and Blood Institute (NHLBI) is considering establishment of a research consortium to improve clinicalresuscitation outcomes from cardiopulmonary and traumatic and posted a Request for Information (RFI) on September 6. SAEMis grateful to Mark G. Angelos, MD, Michelle H. Biros, MS, MD, and Terry Vanden Hoek, MD, for writing the SAEM response thatwas submitted to NHLBI and is published below.

As the national organization for aca-demic Emergency Medicine, encom-passing approximately 5,500 members,the Society for Academic EmergencyMedicine (SAEM) aims to improvepatient care through the advancement ofpatient centered research and medicaleducation. Our mission and vision aredriven by our roles as emergency clini-cians, continuously confronted withpatients suffering from life threateningmedical and traumatic conditions,including cardiopulmonary and traumat-ic cardiac arrest. The frustration of inef-fective, inefficient and poorly studied buttraditional resuscitation interventionshave strongly influenced the developingresuscitation research base of our spe-cialty. Our members are activelyinvolved in many aspects of resuscita-tion research, including basic sciencemechanistic studies, evaluation of pre-hospital EMS systems, and effective-ness of new interventions in the pre-hos-pital, emergency department and in-patient settings. Our members are alsoinvolved in the teaching of CPR to ourcommunities and to hospital staffs, andserve as providers of medical oversightfor Emergency Medical Systems and forcommunities where automated externaldefibrillators are deployed. We havealso provided leadership in a wide rangeof multidisciplinary efforts geared towardthe advancement of acute resuscitationand critical care research, including thedevelopment of the Coalition of AcuteResuscitation Researchers, develop-ment of the PULSE Workshop, and theEmergency Cardiac Care Committee ofthe American Heart Association.

SAEM is supportive of the develop-ment of a resuscitation research consor-tium, and provides these suggestions onbehalf of the Board of Directors.

Organization, Structure, andGovernance of the Consortium

Sudden global ischemia, whetherresulting from cardiac, hypoxemic ortraumatic arrest remains a major chal-lenge for all health care professionalswho attempt successful resuscitation ofthese patients. Mortality is uniformlyhigh, and together these diseases ofglobal ischemia/reperfusion constitute aleading cause of death among childrenand adults. As emphasized by therecent NIH-sponsored Workshop on

Post-Resuscitative and Initial Utility inLife Saving Efforts (summary report pub-lished in Circulation 2001; 103:1182-1184), over 1,000 fully functioninghuman lives each day in the UnitedStates are cut short and lost as a resultof poor cardiopulmonary and traumaresuscitation outcomes. The mortalityrate alone for cardiac arrest outside thehospital is well above 90% on average,and over 98% in our largest cities.Despite the likelihood that there aremany common pathophysiologic path-ways underlying the cause of death inthese patients, the optimal treatment forsuch global ischemia emergencies isclearly inadequate. There are too fewsurvivors at any one institution each yearto critically assess different means ofdiagnosing underlying pathophysiologyand testing new treatments. Thus, a col-laborative consortium of clinical centersdedicated to improving survival from car-diac, hypoxemic and traumatic arrest issorely needed to gather standardizeddata that will include adequate numbersof survivors. Such a consortium wouldthen facilitate new research and gener-ate hypotheses on the pathogenesis andoptimal treatment modalities of suddenglobal ischemia.

SAEM strongly supports initiativessuch as PULSE, which recognize thatencouraging resuscitation research willrequire a multi-agency approach and thepromotion of multidisciplinary communi-cations. Our hope would be that gover-nance of a research consortium toimprove clinical resuscitation outcomesfrom cardiopulmonary and traumaticarrest would further the spirit of thePULSE initiative, and will learn frommodels of clinical consortiums alreadyput in place with the help of the NIH,such as those focusing on cancer, AIDS,and other clinical challenges such as bil-iary atresia. The objectives of this par-ticular consortium should be to establishand maintain the infrastructure requiredfor accrual of sufficient numbers ofpatients affected by cardiac and trau-matic arrest to do adequately poweredclinical studies. As with other consor-tiums, a number of Clinical Centers andlikely Data Coordinating Centers or DataRegistries will be necessary to meet thisobjective.

This consortium should include rep-resentation of principal investigators

from involved clinical centers and DataCoordinating Centers already respon-sive to RFA’s regarding resuscitationresearch and NIH project scientists fromeach of the agencies involved in theresuscitation consortium (includingmany if not all of those agencies alreadyinvolved in the PULSE process).Governance should also reflect the inter-disciplinary input encouraged by thePULSE Workshop, including investiga-tors from the basic, translational, anddevice development sciences. In addi-tion, given the importance of bystanderCPR, representation of the social andeducational sciences will be important indetermining how to change our currentpublic lack of CPR training. Inclusion ofclinical centers will likely change withtime, depending on the research ques-tion being asked and protocols studied.

Developing, Prioritizing andImplementing Clinical Protocols

Development of clinical protocols isclosely tied to basic and translationalresearch efforts in the field of resuscita-tion research. Thus an important aspectof the consortium has to include involve-ment in these non-clinical research are-nas. Communication between clinicalinvestigators, basic science investigatorsand consortium investigators is critical.The best forums for this are scientificmeetings. Sections of resuscitationresearch could be fostered within vari-ous societies, which interact in this areae.g. the Society for AcademicEmergency Medicine, American HeartAssociation, Society of Critical Care, andthe American College of Surgeons.Additional consensus conferences in theformat of the recent PULSE Workshopwould allow prioritizing future researchdirections for the Consortium. NIHinvolvement in these conferences is crit-ical.

Directed research funding whichreflects the specific action items put forthin the PULSE Workshop Summary(Circulation 2001; 103:1182-1184) willbe critical. Specific research directionswere highlighted in the Pulse WorkshopSummary, which can be used to formu-late initial priorities. For establishingfuture priorities, mechanisms thatencourage development of translationalresuscitation research centers which


14

Resuscitation Research Consortium (Continued)

focus on multi-center small and largeanimal resuscitation questions could bequite helpful to the clinical consortium.

Data ManagementData Coordinating Centers or

National Registries will likely be criticalto support the study of clinical resusci-tation. Unfortunately, important clinicalinformation including injury severity,time of ischemia (down time), underly-ing cardiac rhythms or waveform analy-sis, and treatments attempted is oftenlost to further analysis as there are fewincentives and many challenges to inte-grate this information into standardizeddatabases. Data which will likely be crit-ical to asking good research questionsinclude cardiac arrest events and out-comes (as recorded according to theUtstein template for both out of hospitaland in-hospital cardiac arrests), possi-bly serum and tissue samples, newlydeveloped biosensor data from cardiacand traumatic arrest patients, and car-diac rhythms as recorded by monitoringequipment or automated external defib-rillators (AED’s). Such registries areconsistent with the highest priorityneeds identified by the PULSEWorkshop. The executive summaryemphasizes the need for national reg-istries on clinical cardiac and traumaresearch, with an emphasis on the uni-formity of pre-hospital data collectionand the characterization of injuries,severity, initial management, and out-comes. SAEM applauds efforts such asthe American Heart Association inworking to establish the NationalRegistry of CardiopulmonaryResuscitation (NRCPR), designed tocollect data on in-hospital resuscitation.Efforts to continuously improve suchdatabases and facilitate their use byinvestigators could rapidly accelerateour understanding of what happens dur-ing cardiac and traumatic arrest.

Obtaining Consent for ClinicalResuscitation Protocols

SAEM recognizes that clinical resus-citation research is unique in that duringmost resuscitation events, it may be dif-ficult if not impossible to obtain patientconsent for participation in researchprotocols designed to either study theevents of global ischemia/reperfusion,or to actually improve the currently poorsurvival rates. This is an extremelyimportant issue since most research

conducted by any clinical consortiumestablished will have to face this reality.Clinical research in acute resuscitationby necessity involves critically ill and/ orinjured patients. In most circumstances,the patient’s unpredictable and devas-tating clinical condition will precludetheir ability to provide meaningfulprospective informed consent forresearch participation. Additionally,proxy consent from a legally authorizedrepresentative is usually not possible,given the sudden onset and rapidly pro-gressing nature of the critical pathology,and the short therapeutic windows ofmost acute experimental interventions.In life threatening situations for whichcurrent treatment is unproven or unsat-isfactory, the individual patient, as wellas general medical knowledge, wouldlikely benefit from enrollment into spe-cific resuscitation research protocols,even if prospective consent cannot beobtained.

While SAEM believes it critical to findnew ways to improve the care of ourpatients by improving the currentlyunacceptable survival rates from sud-den global ischemia, we emphasize theforemost imperative that the humanrights of these vulnerable patients con-tinue to be safeguarded by strict stateand federal research regulations. Undervery narrowly prescribed circum-stances, prospective informed consentcan be waived for emergency resuscita-tion research (21 CFR Part 50; 45 CFRpart 46; Informed Consent and Waiverof Informed Consent Requirements inCertain Emergency Research; FinalRules, Federal Register, Oct 2, 1996;61(192): 51498-51533). However,because of the limited research circum-stances that qualify for waiver ofinformed consent, few investigatorshave experience in developing a rea-sonable approach to satisfying the con-ditions of the regulations. Concernsabout the public’s reaction to localresearch efforts that enroll patients with-out their consent, possible liability forresearch performed without prospectiveconsent, and a lack of understanding ofthe regulations themselves have madeIRBs reluctant to advance these proj-ects, or unrealistic in their expectationsof the investigator’s means of meetingthe requirements of the regulations.These concerns of public reaction anddifferences in understanding of currentWaiver of Consent Requirements have

the potential to become one of thelargest obstacles to future resuscitationresearch in the United States, andthereby delay potentially significantimprovement in the care of our patients.Thus, it will be important for any futureclinical resuscitation research consor-tium that issues of consent be handledwith the utmost of clarity, protection ofpatient rights, and involve continuedrepresentation from the public andresearchers. This issue also empha-sizes the need for public outreach by theclinical consortium to educate theAmerican people to what is at stake.

Any consortium for clinical resuscita-tion research must therefore include inits infrastructure, a system to ensureproper adherence to existing federalresearch regulations and provide guid-ance to investigators and IRBs onappropriate implementation of the regu-lations. Also needed would be anorganized communication to allow feed-back for investigators, IRBs and federalregulators about the practical aspects ofapplying the current regulations in theday-to-day performance of research.

To achieve these ends, the researchconsortium might develop a panel orcommittee of experts, available from thestart of the planning of a protocol, tosuggest and monitor issues of informedconsent appropriate to the protocol athand. This group would be responsiblefor knowing the regulations, critiquingthe methods suggested to meet therequirements of the regulations, andproviding surveillance on the implemen-tation of the regulations. In addition, thegroup would monitor problems encoun-tered with implementing the regulations,determine the impact of the regulationson the performance of resuscitationresearch, and provide input to federalagencies as they periodically reassessand revise the regulations.

For maximum patient protection, thegroup would not replace local IRBs, whocould evaluate the suitability of a pro-posed study in terms of the localresearch and cultural environment.Instead the group would serve as anadvisory body for all IRBs consideringthe same resuscitation protocol. This infact would allow a better application ofthe regulations, in that problemsencountered after ethical scrutiny byone IRB could be easily communicatedto other IRBs, and thus be addressedmore readily.


The Top 5 Most-Frequently-Read Contents of AEMDuring the Month of October 2001

Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articlesarchived on AEMJ.org.

Electrocardiographic ST-segment Elevation: The Diagnosis of Acute Myocardial Infarction by MorphologicAnalysis of the ST Segment William J. Brady, Scott A. Syverud, Charlotte Beagle, et al Acad Emerg Med Oct 01, 2001 8: 961-967. (In "CLINICAL INVESTIGATIONS")

A Comprehensive Set of Coded Chief Complaints for the Emergency Department Dominik Aronsky, Diane Kendall, Kathleen Merkley, Brent C. James, Peter J. HaugAcad Emerg Med Oct 01, 2001 8: 980-989. (In "CLINICAL PRACTICE")

Post-resuscitative Hypothermic Bypass Reduces Ischemic Brain Injury in Swine Kazuhisa Mori, Yasushi Itoh, Jota Saito, et al Acad Emerg Med Oct 01, 2001 8: 937-945. (In "BASIC INVESTIGATIONS")

Dispatcher Assistance and Automated External Defibrillator Performance among Elders Rob Ecker, Thomas D. Rea, Hendrika Meischke, Sheri M. Schaeffer, Peter Kudenchuk, Mickey S. EisenbergAcad Emerg Med Oct 01, 2001 8: 968-973. (In "CLINICAL INVESTIGATIONS")

Faculty Triage Shortens Emergency Department Length of Stay Sirous N. Partovi, Brian K. Nelson, Earl D. Bryan, Matthew J. Walsh Acad Emerg Med Oct 01, 2001 8: 990-995. (In "CLINICAL PRACTICE")

15

Resuscitation Research Consortium (Continued)

Needed Personnel, Equipment andSupplies

To date, there has been little empha-sis on research training in resuscitation.In order to advance the knowledge andcare,, it is important to develop trainingand funding opportunities for futureinvestigators. Fellowship training grantsfor physicians interested in developingtheir research skills in the area of resus-citation research will greatly enhanceinterest and opportunities in this impor-tant field. In addition to postdoctoral fel-lowship programs, physician/scientisttraining programs will supply supportand opportunities for additional trainingfor physicians already working in thefield. Areas of study might include pub-lic health, epidemiology, working withEMS systems in areas of trauma andcardiac arrest, as well as basic sciencetraining in areas pertinent to acuteresuscitation.

An important component of researchtraining would include a tracking mech-anism of physician-scientists in resusci-tation science and outcomes to tracktheir careers including resuscitationfunding and new science creation.

Support of basic science is a criticalaspect of training and development ofindependent investigators in the field ofresuscitation research. Basic science isable to pose mechanistic questions anduse models, which allow a deeper prob-

ing and understanding of acute resusci-tation pathophysiology than can beaccommodated by clinical studies.Basic science is critical to the develop-ment of future therapies. These effortsfuel new clinical studies.

Initial development of this consor-tium should include those who interfacewith the acute resuscitation of thesepatients. This would include EMS sys-tems personnel and Medical Directors,Emergency Physicians, Traumatolo-gists, Epidemiologists, and the appro-priate support staff. It is likely that sucha consortium would consist of geo-graphically diverse individuals.Consequently, regular communication isessential. This could include Internetconferencing, regular investigator meet-ings as well as NIH sponsorship of fol-low up conferences to the PULSEWorkshop held in June 2000.

Initial consortium setup wouldinvolve developing national registries toidentify and characterize the problemsof acute resuscitation. Such a consor-tium would involve data accumulationfrom many sites. This would require theset up and maintenance of secure andreliable communications networks.Presumably this would involve theInternet. Resources (personnel, com-munications equipment, computers,etc.) to maintain multiple national reg-istries would be required. This consor-

tium would involve more than a singleregistry. Both cardiac arrest and traumaare diversely heterogeneous diseases,which can be subdivided into many eti-ologic subgroups. With sufficient num-bers of patients, as a national consor-tium effort would facilitate, multiple reg-istries directed at the various etiologiesof cardiopulmonary arrest can be setup. These registries would form thebasis for future study protocols gearedtowards specific cardiopulmonary arrestetiologies. Institutions and individualscontributing to the registries would mostlikely be the best study sites forprospective studies.

Other Thoughts Including CostIt is difficult to estimate associated

costs. Costs of such a program mustinclude training programs as well ascosts to physically set up and maintainthe Consortium. A grants mechanismgeared towards generating data andcollaborating with the consortium wouldbe needed. This would allow institutionsto apply on a competitive basis for fund-ing as a benefit of working within theconsortium and funding the institutions’efforts. Additional costs would beincurred in funding of regular investiga-tor meetings and follow up conferencessuch as the PULSE Workshop.

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Research Funding in Pediatric Emergency MedicineCharles J. Havel, Jr., MDSAEM Research CommitteeChildren’s Hospital of Wisconsin

As for Emergency Medicine in gener-al, research in the field of PediatricEmergency Medicine (PEM) is comingof age. Particularly with respect to clin-ical projects, the need now exists forlarger studies with greater statisticalpower to support the conclusions andrecommendations for the emergencycare of children. This meansresearchers are needed to carry outmore multi-center trials with greaternumbers of patients enrolled, a greaternumber of collaborative efforts, andgreater complexity of research ques-tions asked. Thus there is a greaterneed for larger and larger amounts offunding support. The focus of this arti-cle is to identify possible sources for thisfunding and/or directions in which theinquiring researcher might initially moveto acquire such financial underpinning.

Financial support for PediatricEmergency Medicine can be dividedinto three general categories of sources.The first consists of interdisciplinaryagencies, such as the NationalInstitutes of Health (NIH), the Centersfor Disease Control and Prevention(CDC), and other local, state, and feder-al governmental agencies. The secondis comprised of organizations sponsor-ing general Emergency Medicineresearch, such as the EmergencyMedicine Foundation (EMF), Society forAcademic Emergency Medicine(SAEM) grants, and the NationalEmergency Medicine Association GrantProgram. Lastly, there are the sourcesthat concern themselves strictly withresearch in Pediatric medicine orPediatric Emergency Medicine. Thisarticle will concentrate on identifyingsources in this third category. Moredetailed descriptions of the first two cat-egories of funding sources have been orwill be covered in other articles in thisseries prepared by the SAEM ResearchCommittee. However, it is important toemphasize that an application for fund-ing a PEM project in the case of some ofthese sources may be more favorablyreceived than a more general EM proj-ect. Because PEM is a "younger" sub-specialty, work in this area may beviewed as more novel and thereforevery competitive for some of the largergrants.

The Maternal and Child HealthBureau (MCHB, www.mchb.hrsa.gov)

was initially founded as a federal agencyin 1935 by Title V of the Social SecurityAct. It has grown in scope and missionsince that time and currently serves as afederal effort to provide the means toassure the overall health of all mothersand children. Among its many programsare two that may provide options tothose seeking financial support forresearch in Pediatric EmergencyMedicine. The first is the MCHB BlockGrant that in fiscal year 1999 provided700 million dollars for research.Although the Block Grant focuses onprojects that primarily deal with primarycare issues, injury and violence preven-tion also is designated specifically as anarea of interest and is directly applicableto Pediatric Emergency Medicineresearch. The second MCHB programof interest to Pediatric EmergencyMedicine researchers is EmergencyMedical Services for Children (EMS-C,www.ems-c.org). This is a nationaleffort dedicated to improving emer-gency care to pediatric patients includ-ing adolescents. EMS-C goals are toensure the delivery of state of the artemergency care to pediatric patients,full integration of pediatric services intothe EMS system, and provision of thefull spectrum of primary, secondary, andtertiary prevention to children and ado-lescents. EMS-C will provide federalmonies not only to fund research, butalso sponsors grant-writing workshopsfor investigators seeking to develop skillin this area and a grants alert web pub-lication to notify investigators of otherfunding sources of interest (www.ems-c.org/funding/framefunding.htm).

The Ambulatory PediatricAssociation (APA, www.ambpeds.org) isan organization of academic pediatrichealth professionals focused on primarycare. The stated goal of the APA is tosupport excellence and innovation ineducation, research, and health caredelivery to pediatric patients. Amongthe programs that support research isthe Young Investigator Grant. Up to$10,000 per project may be awarded tonew investigators for research in a num-ber of areas, including PediatricEmergency Medicine. This grant wouldbe particularly applicable to those intraining or junior faculty in the earlystages of their research career.

Another academic pediatric organi-zation, the paired American PediatricSociety and the Society for PediatricResearch (APS/SPR, www.aps-spr.org)

focuses on facilitating research in anumber of areas of Pediatrics. The APSserves to bring together those who areactive in advancing the study of childrenand their diseases. SPR for its part pro-vides encouragement to young investi-gators involved in research of benefit tochildren and provides a forum for theexchange of ideas and presentation ofwork. Together, APS/SPR sponsors theMulti-center Clinical Studies Programthat, as its name suggests, funds multi-center clinical trials through seedmonies to support these investigations.

In similar fashion, the PediatricEmergency Medicine CollaborativeResearch Committee (CRC,www.aap.org/sections/PEM/pemcrc/pemcrc.htm) functions under the auspicesof the American Academy of Pediatrics(www.aap.org). The CRC provides arange of services to individualsengaged primarily in clinical investiga-tions applicable to Pediatric EmergencyMedicine (www.aap.org/sections/PEM/default.HTM). Collaborative proposalsare reviewed and recruitment of othercenters is facilitated for approved proj-ects. Junior investigators may receiveassistance not only developing propos-als for collaborative work, but also limit-ed guidance with respect to studydesign and statistical analysis.Although not a funding source per se,the CRC will investigate sources offunding for approved studies. Lastly, theCRC reviews nominations and makesthe final selection for the Ken GraffJunior Investigators Award (www.aap.org/sections/pem/pemcrc/dlgraff.htm)named to honor a pediatric emergencyphysician.

A final option not to be overlooked,particularly for junior investigators whomay have smaller projects in mind, aresources situated within their local terti-ary pediatric referral center. As anexample, The Children’s HospitalFoundation of Children’s Hospital ofWisconsin (www.chw.org) carries out avery active research grant program thatsupports investigations within theChildren’s Health System, encompass-ing a number of different institutions.Similar opportunities likely exist in otherlocations and funding may be availableparticularly if there is an establishedreferral system or some other pre-exist-ing relationship between institutions.

17

Tales…OpportunityMarcus L. Martin, MDSAEM PresidentUniversity of Virginia

A definition of opportunity is a "time or circumstance whichis favorable to some purpose." In this tales from the crib(home) I discuss the opportunities provided to me to becomean emergency physician. Propitious moments came along forme to enter medical school. I was given the opportunity toenter the field of medicine and embark upon a career whichhas been quite rewarding. A key link to any successful venture(career, personal relations, business, etc.) is to be given theopportunity to participate.

I grew up in a small mountainous paper mill town with most-ly an uneventful childhood. I was drawn to academics and sci-entific inquiry at an early age. I attended a small all black highschool with 40 students in my graduating class. One of myresearch projects in high school science class was a fermen-tation experiment using the GAP technique. GAP stood forGrapes, Apples and Potatoes. These were readily availableresources in the rural setting. This project was unassigned,unmentored and unsupervised since our science teacher wasusually absent from class. Our science teacher was oftenpulled to go to other schools to teach. There were no controlsand my co-investigators and I were probably out of control.Our experiment took place at one site in the classroom setting.It was simplified the way NIH likes it. The method included put-ting GAP in water and sugar, and yeast and an old sock or twointo bottles. We were anxious for analysis of results and peerreview. Since occasionally caps blew off the bottles (a goodsign), we knew we would all be "blinded" if we tried it. Theresearch was evidence-based, adventurous but not the mostoriginal. The day before the big homecoming game, after foot-ball practice, we tried to transport the results of the researchout of a school passageway. I won’t tell you all of the story butI had to rely on blazing speed and quickness that I inheritedfrom my legendary great-grandfather "Roscoe Gone With theWind" and grandfather "Quick John Willie Show Me the MoneyMartin." Although considered good quality research by theinvestigators the results never reached peers for review. Thankgoodness! I was really fortunate this adventurous escapadedid not end in some other outcome. Prodigiously, I becamemore involved in traditional high school scientific endeavors,which led to state awards and a scholarship to North CarolinaState University. Sadly, however, due to lack of science enrich-ment and mentoring, many of my classmates did not go to col-lege, an opportunity they missed.

I was fortunate to receive a scholarship through theDepartment of Forestry at NC State University having a dou-ble major in Pulp and Paper Technology and ChemicalEngineering, a five year degree program. During my summers,I conducted various studies on the brightness and tensilestrength of paper, recycling of waste pulp fibers, developmentof more efficient bleaching steps and recycling newsprint, thegray colored paper that you see in cereal box liners. Aftergraduation from college, I worked two years as a productionengineer in the paper industry before embarking on a medicalcareer.

My decision to pursue a medical career was influenced bya tragic event at work. One weekend late night as the pulp millproduction engineer in charge, I supervised the repairs of a

large leaking pulp line. The repair work took place about 30feet in the air on scaffolds. Around 3:00 am, due to exhaustion,I was relieved of my duties by my boss who had his doctoratedegree and was the assistant mill manager. Unfortunately,later at home I heard the sirens of the local rescue squads.One of the machine operators had accidentally pushed a but-ton that started the pumps delivering hot caustic/pulp materialthrough the large pipeline where the men were working. Theywere burned and fell 30 feet to the ground, sustaining secondand third degree burns and multiple fractures. It was a nearmiss for me having been in the work area earlier. Fortunately,no one died, but there was extensive morbidity associated withthe incident. I later visited my boss in the hospital and devel-oped my first real interest in medicine and later applied to med-ical school. I was fortunate to become a charter member ofEastern Virginia Medical School entering with 23 other stu-dents in 1973.

Being modestly productive academically in college with twomajors, carrying 21 hours some semesters, chartering a fra-ternity and playing football, I am glad I am not competing withtoday’s medical school applicants. You might say I was a prod-uct of affirmative action during the early 1970’s. Yes, an oppor-tunity! My research and production engineering career in thepulp and paper industry ceased. I went on to complete med-ical school in three years and to obtain training and mentoringin the United States Public Health Service (USPHS) as acommissioned officer and also as a general medical officer inthe Indian Health Service in Gallup, New Mexico. I missed anopportunity to obtain a public health masters degree while amember of the USPHS. However, I obtained an outstandingeducation during my two years of Public Health/Indian HealthService. I also learned tremendously about another culture asI was immersed among members of the Navajo Nation.

I had an opportunity to work in a locum tenens fashionabout nine months before entering my residency in EmergencyMedicine at Cincinnati. My first opportunity to participate in anational meeting was at the 1981 UAEM meeting in SanAntonio where I presented research on phenytoin solubility.What I missed though was the opportunity for fellowship train-ing. There were not many fellowships during those days. Onlya few Emergency Medicine physicians were entering toxicolo-gy, EMS, or research fellowships. It has been a joy to see themany more fellowship opportunities in Emergency Medicinedevelop over the recent years.

Upon completing residency in Emergency Medicine atCincinnati I went to Allegheny General Hospital in Pittsburghwhere I spent 15 years in academic Emergency Medicine. Ileft Pittsburgh to go to the University of Virginia where I am cur-rently Professor & Chair of Emergency Medicine, anotheropportunity I am privileged and fortunate to experience. I haveappreciated my educational opportunities and work experi-ences and I encourage physicians considering an academiccareer in Emergency Medicine to take advantage of the won-derful opportunities available to you to enhance your produc-tivity in research, education, and clinical care. I hope you seizethose "times or circumstances favorable to your purpose." It ismy pleasure and certainly a distinct opportunity to serve asSAEM President.

18

ACADEMIC RESIDENT

James Adams, MDSAEM Board of Directors Northwestern University Medical School

Social values of our current market-driven, financiallycompetitive economy make it difficult for physicians to actwithout self-interest and remain focused only on patient need.Because of these circumstances, it is particularly dangerousto take professionalism for granted. At stake is our integrityand, with it, our power. In each preceding modern era,insightful and caring physicians have persevered throughtheir own challenges to professionalism. Now it is our turn.We must promote honor in order to maintain the trust of thepublic. It is worthwhile to reflect on our current professionalenvironment and ensure we are proceeding on a successfulcourse. This brief essay is meant to be provocative. It willdescribe the need for professionalism and question somecurrent assumptions. A case will be made for heightened vig-ilance.

Professionalism is more than competence.Professionalism is defined simply as behaviors that place

the interests of the patient ahead of one's personal interests.In practice, this is not so simple. All behaviors and actionsrelated to our physician role are involved, including directpatient care decisions, relationships with the biomedicalindustry, and relationships with colleagues.

Maintaining professionalism requires more than deliveringtechnically competent care. Physicians are also responsiblefor maintaining high standards of practice, educating futuregenerations of physicians, providing unbiased scientific andethical leadership, while ensuring that the interests ofpatients are promoted.

Why the need for professionalism?Without professionalism, we are no more than technicians

exercising a trade. The difference between a job and a pro-fession is the deference accorded by society, reflected in trustand respect. Because of such deference, professionsautonomously set standards of education and performance.Professions regulate themselves and are accorded specialprivileges, such as the ability to establish rules of conduct.Successful professions ensure that members behave accord-ing to self-imposed principles. As part of the governing free-doms accorded, the members themselves determine compe-tence, discipline the members, and even select who isallowed to enter.

Some other important skills are not socially constructed asa profession, such as art, music, and writing. Other jobs haveprestige because of high standards for education, such asteaching, engineering and architecture, but are limited in pro-fessional standing because of high variability surroundingentry, oversight, and performance standards. Notably, as thestandards are made consistent and high levels of perform-ance demanded, prestige and influence increase. Medicine

has historically been viewed as noble and, therefore, hasbeen granted the most deference. This is true because of themaintenance of rigorous, high expectations of those whopractice medicine, along with the practitioners’ devotion to thepatient.

It is useful to think about this in comparison to business,manufacturing, and finance. Any person can claim businessskills, with or without training. This is the hallmark of our soci-ety. Business schools have long struggled to define them-selves as a profession, with only partial success. The busi-ness schools began to gain professional stature as they ele-vated entrance and performance standards for their MBAcandidates. Even so, the schools maintain that one of the keyadvantages is the networking opportunities afforded throughalumni connections. Business schools struggle with profes-sional identity even as they and their graduates are financial-ly successful.

In medicine, however, there is a clear expectation for pro-fessional standards and accountability. Physicians define thepractice, set the standards, and control who enters.Physicians are allowed to do so because of both the techni-cal nature of the field and also because of the unequivocalfocus on the good of those served. In business there are nosuch expectations since the marketplace, capitalistic forces,and the law control behaviors. The goal of business is to gen-erate shareholder return. Maybe medicine is headed this way,moving out of the realm of profession, becoming a business.We can see some of the problems with the loss of profes-sionalism by the lessons of the legal profession.

Traditionally, doctors, lawyers, and the clergy were the 3recognized professions. In the law, society has lost some ofthe benefit associated with high levels of professionalism.Thelaw has unsuccessfully maintained its stature because of theinability or unwillingness to address the nature of the profes-sion and govern behavior. The law believes that justice is bestserved through rigorous argument, so this limits professionalconsensus. As an inherently adversarial profession, behav-iors are competitive. As competitive behaviors increasinglycenter on money rather than justice and client-centered prin-ciples, the law becomes increasingly disrespected. The lawcannot succeed as a business, governed by the marketplace.The loss of professional integrity means the loss of society’srespect. If attorneys advocate for their own interests, over theinterests of individuals or society, honor is lost. To the degreethat this has happened, there has been diminished respectand reverence, along with weakening of the profession. Nowthe law is sometimes disparaged even as lawyers continue tobe needed. If medicine allows weakening of professionalunderpinnings, we will suffer the same fate.How is professionalism manifested?

Professionalism demands a standard of behavior higherthan the marketplace demands, higher than capitalismdemands, and higher than law demands. Professionalismrequires ethics, honor, integrity, and a service orientation.Emergency medicine in particular continues to reaffirm such

News and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

An Argument for Professionalism

19(continued on next page)

ideals and promote high standards. Nobody expects this ofbusinesses, but businesses are not accorded the same socialstatus or control that is afforded to the medical profession. Ifmedicine is to preserve and enhance professionalism in orderto preserve the trust of society, what does this mean to theindividual in practice? How is professionalism manifested inour daily lives? A few examples may begin to help illustrate:

Case 1: The Journal of the American Medical Associationreviewed a manuscript that reported on a large, multi-center,prospective, randomized trial. The research was apparentlywell conducted and showed therapeutic benefit of a newdrug. The authors were asked to report the contribution thateach individual made to the project. The study was funded bythe biomedical industry and conducted with the support of thecompany. The editors of JAMA asked the authors whetherthere was one person who had unrestricted access to thedata and who could vouch for the integrity of the analysis andthe results, but who had no conflict of interest. In order toassure absolute integrity of the study, the editor asked if therewas any author who had not received compensation from thecompany that could guarantee the results.There was no suchauthor and the study was not published.

Why did JAMA act this way? The study was good. Yet theeditors realized that the journal’s main currency is integrity.Unless the trust of the public and the practicing physicians ispreserved, the journal has little more to offer than an industrypublication reporting on science. As a profession, as a holderof public trust, JAMA must hold honesty and the public goodin highest regard. It is easy to believe that this is not a bigdeal. But integrity is fragile. Trust is easily lost. It is essentialto remain above suspicion. The highest standards are essen-tial. The editors know all of this and the journal will remainsuccessful because of it.

Case 2: Physicians attended a golf tournament and sub-sequent dinner that was funded by the biomedical industry.The representatives of industry were present, but there wasno formal discussion of products or prescribing. No requestswere made of the physicians.

The physicians received a benefit yet believe that theywere not influenced. This is the delusion that allows market-ing to be successful. People rarely can be influenced if theyare aware of it. Still, the impact of such efforts is easy to proj-ect and easy to quantify, even as the involved physicians con-tinue to deny the impact.

Commercials lure with entertainment, comedy, sexuality,and sensuality. The key to success is to disarm and brieflycapture the mind. Behavior changes follow, without aware-ness. Few will admit that television commercials or print adsinfluence their individual behavior.Yet these create an image,a feeling, an attitude in the subject. These attitudes drivebehaviors that positively impact the businesses’ shareholderreturn.

This is not an argument against industry, by the way.Businesses only do what contributes to their success.Further, the biomedical industry is a great strength of ourhealth care system. More money is spent on research byindustry than by the National Institutes of Health. Industry hasprovided some of the most important modern medical break-throughs. The pressing current concern is not business prac-tices, it is maintenance of physician objectivity. Objectivity willserve the patient best. If we wish to maximize professional-ism, we will ensure that our interactions and decisions havelittle potential bias.

Case 3: The New York Times recently published an articlecondemning the New York City EMS system for not carryingamiodarone. After all, the article stated, a recent studydemonstrated that it improved survival rates of patients in car-diac arrest. This struck fear into some emergency physiciansbecause a standard of care was being promoted. The deci-sion to use amiodarone should not be forced by newspaperarticles or industry promotion. The research never demon-strated a survival benefit, but only described a return of spon-taneous circulation with out-of-hospital use. High dose epi-nephrine will also increase rates of return of circulation, butwill not increase neurologically intact survivors. High doseepinephrine is not the standard of care for this reason.Perhaps if the high dose epinephrine data only revealed therates of spontaneous circulation and if it was also highly prof-itable, it would be in algorithms. There is no data that supporta 1mg dose of epinephrine, after all.

Yet amiodarone is more profitable, so is being promulgat-ed as a standard even though the data do not demonstrateincreased rates of neurologically intact survival after out ofhospital use. If the drug becomes the standard, no furtherresearch demonstrating neurologic recovery will be needed.One way to promote use is to get lots of attention and influ-ence physicians through publications, symposia, media,"expert" physicians, and aggressive marketing. It will probablywork, which means that a little science and a lot of promotiondrive changes in care standards rather than a lot of scienceand objective physician decisions.

This is not the fault of industry, by the way. The manufac-turer is doing their job well, which is to provide a return forshareholders. The physicians are the ones with the profes-sional responsibility for medical decision-making. We are theones challenged to objectively set the standard for the UnitedStates public and for our individual patients. The relationshipwith industry becomes complicated since the fundamentalgoals are different. If physicians accept financial compensa-tion from industry, we have to worry about subsequent threatsto autonomy and professionalism.

Physicians must remain vigilant, independent, and worthyof the public's trust. We must remain independent of undueinfluence and clearly, even aggressively, establish the properstandards of care. Honest differences of opinion are expect-ed, even encouraged, as the science emerges. If amiodaroneproves beneficial, and I hope that it does, physicians shouldquickly adopt it. Industry should be positively regarded for thesupport of the science, should be allowed to properly dis-seminate information about the drug, and be respected for itsimportant role in our health care system. Industry should not,however, be the ones to drive standard of care decisions.Thisis up to objective medical professionals.

Case 4: A patient presented to a community hospital 1 1/2hours after the onset of acute left sided weakness. A head CTscan was rapidly ordered, blood tests were ordered, and thepatient was rapidly stabilized. The 3 hour window for throm-bolytics passed and the drug was not administered. Thepatient had a dense hemiplegia, was disabled, and suedbecause thrombolytics were not administered.

There is a lack of evidence that thrombolytics can be safe-ly used in the typical emergency department, under usualconditions, for the treatment of acute stroke. Evidence sug-gests that it is more dangerous than beneficial unless a rig-orous, but resource-intensive system is developed to supportits use. This is not currently available in most hospitals.Despite good evidence that the systems of care in many hos-

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An Argument for Professionalism (continued from page 13)

pitals do not support the safe use of thrombolytics, they arestill promoted as a standard of care, not always heralded byreason, science, and physician judgment, but by public rela-tions, media, and experts funded by industry. I am unaware ofany research paper that has demonstrated the safe use ofthis agent in usual emergency department conditions. Allresearch has demonstrated dangerous protocol violationsand the potential for increased danger to patients. On theother hand, a physician may be able to confidently administerthe drug after assessment of risks and benefits. So whoshould decide? Who is setting the professional standards? Isit industry, the law, or autonomous physicians guided by rea-son, integrity, balanced assessment of the science and thepractical implications? Every physician operates under theillusion that he or she is such a reasoned professional. Theequally important question, however, is who is establishingthe premise behind the reasoning?

It is not possible to claim that we are not influenced byindustry. After all, more stroke patients are harmed from aspi-ration than could benefit from thrombolytics. We have noaggressive campaigns to increase attention to head position-ing and suctioning, though. Technology and industry get moreattention than low-tech, but highly beneficial treatments.Aspiration precautions will not capture the attention of well-meaning physicians. We all know why. We must then ask whois driving the medical profession, physicians or the biomed-ical industry? Is industry taking over control of the standardsof care, of innovation, of demands for excellence? Are we justalong for the ride?

Where will the future lead?As marketplace incentives continue to hold sway, will

physicians subordinate personal financial interests for thesake of objectivity? Will physicians remain outside the realmof marketing in order to remain critically observant? Becauseof uncertainty, there are many external agencies which wouldlike to regulate physicians because of faltering trust. They willbe successful unless physicians maintain, monitor, andmodel the highest of professional ideals.

A few professional challenges are described in this essay,but only very few.

Some other issues of increasing professional importanceinclude:

1. Behaviors toward colleagues2. Interactions with patients3. Honesty, deceptiveness, and shading the truth.4. Interactions with insurers5. Documentation and compliance6. Elimination of bias and prejudice

Each of these is complex and worthy of similar provocativediscussion. This essay illustrates just a few examples in orderto challenge the reader. The trust of the public, preservedthrough our autonomy, our suspension of self-interest, andour integrity, strengthens us. It is our primary source of influ-ence. Without this, we become a mere trade, a remnant of aprofession, and will see our stature fall. As we confront mar-ketplace forces we must reinforce our integrity. We must but-tress ourselves. Integrity is easily compromised and hard torestore once lost. Each of us has the duty to protect and pre-serve the profession. It is an honor to work with colleagueswho are models of professionalism. I congratulate you inadvance for your ongoing commitment to these principles.

Resident Research: The Basics & BeyondBrian Zink, MDSAEM Board of DirectorsUniversity of Michigan

Scientific investigation is the basis for and foundation ofmedical practice, including emergency medicine. Althoughnot everything we do is derived from careful scientific inquiry,research has advanced our knowledge and allowed us tohelp patients in every aspect of care. Consider a typicalpatient who presents to the ED with a severe headache.Emergency physicians have studied and given us objectiveinformation on everything from the effectiveness of triage byED nurses for this class of patient,1 the sensitivity and speci-ficity of head CT and lumbar puncture (LP) for diagnosingsubarachnoid hemorrhage 2, and the incidence of spinalheadache if a LP is performed 3. If the patient turns out tohave viral meningitis, emergency medicine investigators haveconducted clinical trials on the usefulness of a new antiviralagent, pleconaril, for treatment 4, and basic science EMinvestigators have just published a study in rats suggestingthat Anti-Interleukin-6 antibodies can attenuate inflammationin a model of meningitis.5The Basics

The logical extension of the fact that emergency medicineclinical practice is based on research, is that EM residentsshould have formal training in the fundamentals of researchand how to review and evaluate the scientific literature. The

breadth and depth of EM research training is variable andopinions vary widely amongst EM educators on how researchshould be taught to resident physicians. In most residencyprograms research training is accomplished through a com-bination of didactic presentations on the basics of scientificinvestigation, participation in journal clubs that evaluate thescientific literature, and involvement in ED clinical projectswhile working ED shifts. Some residency programs requireresidents to complete a research project to fulfill the RRCgraduation requirement for a scholarly project. The value ofmandated resident research has been previously debated,with some questioning the value of forcing a resident who haslittle enthusiasm for conducting research to do a formalresearch project. 6,7

The importance of research training for EM residents canbe eclipsed by other elements of the curriculum and clinicalservice commitments. But just as a resident who feels defi-cient in interpreting ECG’s will correct this deficiency throughextracurricular study, or review of ECG’s with a mentor ortutor, so should a resident who is deficient in the basics ofresearch pursue extra training.

A moral and ethical imperative exists for the study ofresearch methodology by emergency medicine residents.

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Our patients obviously count on us to be able to improve careand introduce new treatments or preventive measures. Wecannot do this if we are not able to intelligently immerse our-selves in the world of scientific investigation. While this doesnot mean that we all need to do research, the best EM clini-cians understand basic research concepts and how thesetranslate into care at the bedside. Another good reason tostudy research methodology is to develop the tools to sepa-rate marketing propaganda from sound science. The medicalmarketplace, like other areas of commerce, is teeming withvendors who present information to physicians that isundoubtedly and appropriately biased toward their products.The only defense for the bombardment of medical advertis-ing is an objective, scientific mind that results from adequatetraining in research.

In the past the physician has served as an all-knowingrepository of medical facts and techniques. Now, the averagecomputer-literate patient can learn almost as much about hisor her disease from the Internet (and sometimes more) thanthe physician knows. The role of the physician is being trans-formed from holder of information to interpreter and advisorfor information. A strong foundation in research is essentialfor the physician to fill this role. By understanding funda-mental research concepts such as hypothesis testing, studydesign, data collection and interpretation, and the limitationsof research, the emergency physician can help patients makedecisions about their care.

A number of resources can be used by EM resident physi-cians to further their knowledge of basic research concepts.A full accounting is beyond the scope of this article, but hereare some suggestions: SAEM has produced a Fundamentalsof Research and Advanced Research Series video sets,which are compilations of lectures and handouts on researchthat were presented by senior investigators at SAEM AnnualMeetings. They should be considered essential viewing forall emergency medicine residents. (See the SAEM website atwww.saem.org) for information. Academic EmergencyMedicine offers in almost every issue articles on researchconcepts, methodology, and ethics. 8,9 Annals of EmergencyMedicine has produced a valuable series of articles on bio-statistics and a basic emergency medicine research guide,and frequently publishes articles on theory, design, interpre-tation of clinical research.10,11 A popular and quite readablebook on clinical research that is often recommended by EMfaculty is Hulley and Cummins, "Designing ClinicalResearch" (Williams and Wilkins).

While methodology and analysis receive a lot of attentionfrom those who are training in research, a major area thatmust not be neglected is research responsibility and the eth-ical conduct of research. Recent examples of breaches ofpatient confidentiality, conflict of interest, and failure to prop-erly obtain informed consent have focused national attentionon clinical research. An excellent collection of papers, posi-tion statements, and recent developments on matters relatingto responsible conduct of research can be found at theAmerican Association of Medical Colleges (AAMC) web siteat www.aamc.org/research.Advanced Research Training for Residents

Some residents will go beyond the curricular requirementsfor research and beyond additional reading or study, anddesire a hands-on, mentored research training experienceduring residency. This can be a rewarding way to gain adeeper understanding of research and to assess whether acareer that involves original research is appealing. Note that

the term "research training" is used and not "performresearch" – the two are not the same. Although a well-designed research project can be a good vehicle for a resi-dent to learn about research, a meaningful research trainingexperience will be more broad-based. The motivation for andexpectations of the research training experience on the partof the resident must be clearly defined prior to starting. Thereare good and not so good reasons to do research as a resi-dent.

Good Reasons 1. A compelling interest in an area of medicine, and a

passion to learn more about this area.2. A strong desire to develop research skills and knowl-

edge in a mentored environment.3. Identification of a specific research question that can

be answered by a defined, limited study.4. To assess whether an academic career that involves

research is desirable.

Not So Good Reasons1. To completely answer a major clinical dilemma through

research (see reality and logistics below).2. To publish papers in order to build a strong C.V. and

get a good job.3. To meet an expectation or requirement that "all resi-

dents should do research."

Realities and Logistics of Resident ResearchThe excitement and passion that initially drives an EM res-

ident to pursue additional research training almost immedi-ately runs into predictable roadblocks. How the resident faresin negotiating early obstacles is crucial to whether theresearch training experience will be a positive or negativejourney.

Resident research should not be a solitary pursuit.Having a research mentor to educate, guide, and sometimesconsole the resident researcher is absolutely essential. Ashas been noted before, the mentor need not be an academ-ic emergency physician, but may be an expert in the field ofinterest. 6,7 The resident should look for someone who has atrack record of mentoring junior researchers. Often morethan one mentor may be necessary. The resident researchermust develop an understanding with the mentor at the onsetof the research as to the amount of time, contact, meetings,and skills that will be taught as part of the mentor relation-ship. The resident must clearly define his or her expectationsfor the mentor. For example, a senior resident who wants toperform a pilot project on ED asthma prior to writing a fellow-ship grant, and who plans to pursue an academic researchcareer, is much different than a resident who plans a careeras a community emergency physician, and wants to spend amonth learning from the mentor how clinical studies aredesigned and carried out in the ED so that he will better beable to understand the clinical literature. The mentor will takea different approach with these two residents, but must clear-ly understand their expectations and needs up front.

Once the resident acquires a mentor, the next step is toplan the research training experience. The novice researcheralmost always over-estimates what can be accomplished in adefined research training period, and the mentor usually pro-vides needed reality testing and revision. In order to avoidthe disappointment that inevitably occurs when a researchproject is only 10% complete at the end of the research train-


22

ing period, the resident must work closely with the mentor todevelop a defined, feasible research project. The stepsinvolved include a careful review of the literature in the area,revision of the general research question down to a specificnarrow question, the development of a hypothesis that can beanswered by a simple study, and careful planning of theresearch protocol. If the resident only has a month to performthe research, all of these preliminary steps should be carriedout in advance so that the dedicated time can be spent onresearch, not paperwork. Common snag points as theresearch is being planned include Institutional Review Boardapproval for clinical projects and Animal Care approval forlaboratory projects. For clinical protocols, working out thelogistics of how patients will be identified, recruited andenrolled in the study requires a great deal of time and plan-ning. For laboratory projects, pilot studies or trial experimentsare often needed to perfect the model. Often, the mentor hasalready done the ground work for projects. But even if aresearch project is teed up for the resident researcher by thementor, the resident should still study these aspects of plan-ning the investigation, as they are a key part of learning howto do research.

One challenge for a resident who is doing research, is toavoid measuring success by whether or not the project"worked". In many cases the research project proves too dif-ficult to accomplish in the given time frame. Enrollment maybe slow, animals may die unexpectedly during a protocol, adatabase may not be accessible or may not contain thedesired information. These setbacks are part of research,and are more common when an investigator is just gettingstarted. Setbacks are also essential to learning how to doresearch. Just as in the clinical setting we remember andlearn more from our mistakes, in research we learn from thethings that went wrong and develop ways to avoid these aswe move forward. A good mentor can anticipate some ofthese setbacks and help the junior investigator avoid them.An even better mentor will let the junior investigatorencounter some adversity, and then teach how to reassess,retool, and move forward. Thus, the resident researcher mustevaluate a research training experience based on "what Ilearned," not "what I accomplished."The Important Role of Emergency Medicine PhysicianScientists

A resident research experience is valuable simply as away of increasing a young physician’s knowledge of the worldof scientific investigation. It may be even more valuable inhelping that physician determine where he or she fits in thatworld. Career satisfaction can be distilled down to someessential points – it’s nice to be wanted, better to be needed,and those who feel that they are making a difference are theones who come to work with smiles on their faces. A careeras a physician scientist can wonderfully fulfill these key ele-ments for some emergency medicine residents. Clearly, thedemand and need to increase the number of physician inves-tigators is a national emphasis, as is the need to improveresearch training. Funded opportunities for research trainingfor graduating residents are at an all time high. Sourcesinclude the SAEM Research Fund grants, the EmergencyMedicine Foundation, and a variety of physician researchtraining programs from the National Institutes of Health, manyof which focus on patient-oriented research training.

Can well-trained emergency physician-scientists make adifference in the health of our emergency patients? Theanswer is emphatically yes – from injury prevention and treat-

ment to emergency cardiac care, to asthma, to domestic vio-lence, to public health (to name just a few) emergency medi-cine investigators have taken a leading role in driving theresearch that has improved understanding and helpedpatients. Without their effort, our ability to provide importantadvances in medical care for ED patients is doomed to stag-nate. If the emergency medicine-clinician cannot objectivelyincorporate information from EM research into practice, thisrole will be inappropriately delegated to non-EM specialists,such as corporate entities or the legal system to determineour "standard of care".

Thirty years ago there was a great need for trained emer-gency physicians, and many people helped fulfill this needwhile developing satisfying career in the field. Now we havea need for more, and better trained emergency physician-sci-entists. While this path is not for everyone, it can lead to astimulating, extremely satisfying career. And if enough peo-ple take this path, it will become a highway to better health forour emergency patients.

References1. Wuerz RC, Milne LW, Eitel DR, et al. Reliability and

validity of a new five-level triage instrument. Acad EmergMed, 2000; 7(3):236-242

2. Edlow JA, Wyer PC. How good is a negative cranialcomputed tomographic scan result in excluding sub-arachnoid hemorrhage? Ann Emerg Med. 2000;36:507-516.

3. Trott SD. Lumbar puncture in the emergency depart-ment complications and their costs. (Abstract) AnnEmerg Med. 1999;34(4):S102.

4. Pollack CV. Pleconaril treatment significantly improvesoutcomes for enteroviral meningitis patients with themost severe disease.(Abstract) Acad EmergMed.2000:7(5):

5. Marby D, Lockhart GR, Ramond R, et al. Anti-inter-leukin-6 antibodies attenuate Inflammation in a ratmeningitis model. Acad Emerg Med. 2001; 8(10):946-949.

6. Biros MA. Reforming a solitary passion. Acad EmergMed. 2000;7(5):421-424.

7. Zink BJ. Emergency Medicine Research – no moreexcuses. Newsletter of the Society for AcademicEmergency Medicine. 2000;XII(3); 1

8. Lewis LM, Lewis RJ, Younger JG, et al. Research fun-damentals: I. Getting from hypothesis to manuscript: anoverview of the skills required for success in research.Acad Emerg Med. 1998;5(9):924-929.

9. Kwiatkowski T, Silverman R. Research fundamentals: II.Choosing and defining a research question. AcadEmerg Med. 1998;5(11):1114-1117.

10. Gaddis ML, Gaddis GM. Introduction to biostatistics:part 1, basic concepts. Ann Emerg Med. 1990;19(1):86-89.

11. Whitley TWQ, Spivey WH, Abramson NS, et al. A basicresource guide for emergency medicine research. AnnEmerg Med. 1990; 19(11):1306-1309.

Nominations for the Resident Member of theSAEM Board of Directors are due on February 1,2002. See details on page 10 of this Newsletter.

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opment and manufacture of neededtherapies, vaccines and medical sup-plies; and enhancing the safety of thenation’s food supply and protecting ouragriculture from biological threats andattacks. More information may beobtained by accessing (http://www.sen-ate.gov/~frist/). Both ACEP and SAEMboth are in support of this important leg-islation.

Senator Frist entertained a few ques-tions from the conference members; theEmergency Medicine representativecommented to Senator Frist that the EMphysician community in particular wouldbe on the "front line" to chemical – bio-logical events. It was pointed out that theED is the "portal of entry" to hospitalsand rapid diagnosis, treatment, andappropriate decontamination would bedone in the ED for the benefit of thepatient as well as for the protection ofclinical staff of the rest of the hospital.The senator received one or two morequestions, then excused himself fromthe meeting to attend related matters.The senator’s goal in attending thismeeting was to obtain letters of supportfor his important legislation. It may be toboth SAEM and ACEP’s interest to asktheir members to write SenatorsKennedy and Frist office to show anoverwhelming level of support from the

Emergency Medicine community.The various representatives then

were each allotted time to describe theactivities of their organizations regard-ing disaster preparation. Of particularinterest were comments by Richard A.Levinson, M.D., DPA, and AssociateExecutive Director of the AmericanPublic Health Association. He clearlyoutlined an agenda of his organizationfor developing tools for the education offirst responders and EmergencyMedicine physicians in bio-chem-nucdisaster medical response. Heannounced a conference to discuss thismatter for December 8. ACEP is in theprocess of making certain appropriateEM representation is arranged for thismeeting. Other remarks of interest weremade by the AAMC leadership who stat-ed an intention to create a working task-force containing leadership of the med-ical community to make recommenda-tions for the long-term goals of educat-ing future physicians in bio-chem-nucdisaster training. It was felt that a nation-al level taskforce was required since therecommendations would be a significantalteration of the present curriculumpresent in U.S. medical school training.In addition, the proposed national task-force would address short-term needsof immediate education of resident

physicians. Emergency Medicine clearlyneeds to have a major voice in thisimportant national taskforce.Comments made specifically by theEmergency Medicine Representative

General comments were made to thegroup of the importance of synergy andcooperation to attain the mutual goals ofmaximizing the nations medicalresponse to potential bio-chem-nuc dis-asters. It was pointed out that variousentities such as ACEP and SAEM havebeen organizing taskforces over thepast few years aimed at the NBC pre-paredness of 1st responders and physi-cians. Language was borrowed fromJoseph F. Waeckerle, MD, thatEmergency Physicians will essentiallybe "1st responders" given the massivepresentation of patients to the ED in theevent of a mass disaster. Finally adescription of the Nuclear, Biological,and Chemical multiphase training con-tract was outlined and the need to havethe sources to complete the recom-mended goals set forth by the FinalReport dated April 23, 2001. Overall theresponse to the comments appearedpositive – but it is quite clear that most,if not all of the groups represented havetheir own agendas they would like to seefunded.

Physician Readiness Conference (Continued)

prospect of 80 hours. The ACGME has not yet decidedwhether to mandate 80 hours or less to all the RRCs under itby the AAMC will probably have a strong influence. (Does hemean ACGME?)

Patient safety and resident education continue to be dis-cussed. The AHRQ director, John Eisenberg, described theneed for more research in this area and encouraged grantapplications for the next year. The emergency departmenthas traditionally been identified as a high-risk area. TheSAEM mini-conference on medical error, which was pub-lished in the November issue of AEM, provides an excellentbackground to this topic.

Continuing concerns about hospital overcrowding, short-ages of nurses, medical specialists, and inadequate care forthe uninsured fit well with the SAEM presentation on the safe-ty net vulnerability.

The implementation of the HIPAA regulations and theMedicare reimbursement reductions also were discussed in avariety of settings. The AAMC will attempt to work withCongressional supporters to change the proposed activities.

Overall, the meeting covered important topic areas andattempted to relate to the ongoing national crises. Academicmedical centers felt that bio-terrorism might lend itself to theresearch and education capabilities for which they are known.Emergency medicine should be a leader in those centerswhere it has developed a research and education program.

AAMC Annual Meeting Report (Continued)

Geriatric Emergency MedicineResident/Fellow Grants

Available

SAEM, with sponsorship from the John A.Hartford Foundation and the American GeriatricSociety, is pleased to announce the availability ofgrants to support resident/fellow research relatedto the emergency care of the older person.Investigations may focus on basic scienceresearch, clinical research, preventive medicine,epidemiology, or educational topics. Awards maybe up to $2,500 for each project.

Applications for the Geriatric EmergencyMedicine Resident/Fellow Grant may be obtainedfrom the SAEM office or the website at saem.org.The deadline for receipt of a complete applicationat the SAEM office is March 4, 2002 with notifi-cation of selections by May 7 and funding award-ed by July 1.

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President’s Message (Continued)undergoing a historical transformationin the way health care is organized,delivered, and financed, and academicmedicine is headed, without question,toward a future that will be far differentfrom the past."1 "Academic medicine isan industry . . . people want and needwell-educated and highly trained physi-cians, new medical knowledge andhigh-quality medical care. That’s whatour industry makes!" "But no industry,however successful, can expect to goon doing business the same way indefi-nitely." 1

As we plan for the future, visions forSAEM are not crystal clear but there aresome things we should analyze, projectand strive to attain. SAEM’s current 5-year plan was initiated in 1999. In 2004,(2 short years from now) the 5-year planwill have run its course and the next 5-6years will take us to 2010.

In reviewing the current SAEM five-year goals, we are on track in accom-plishing many goals and objectives butthere are others that require further pur-suit. In research, SAEM supports thedevelopment, career longevity and pro-ductivity of researchers in EmergencyMedicine. We are working to increasefederal funding agency awareness ofthe scientific value and the healthcareimpact of Emergency Medicineresearch. It is our objective to increasethe proportion of EM faculty on tenure-eligible investigator tracks and to fund10 SAEM scholarly awards annually.Although we are on track with support-ing the targeted number of scholarlyawards, we will need to secure morefunding and we will need more time tosee measurable increases in the tenure-eligible investigator track participationby Emergency Medicine faculty. In edu-cation, SAEM’s goal is to support thedevelopment, career longevity and pro-ductivity of educators in EmergencyMedicine by developing resources thatsupport excellence, and innovation andincrease funding for teachers throughscholarly sabbaticals. We have initiatedscholarly sabbatical awards and willcontinue to do so. There is opportunityfor continued development of resourcesto support excellence in innovation forteachers. In undergraduate educationour goal is to support excellence inEmergency Medicine education for allmedical students and develop initiativesthat encourage and support studentswho may be interested in pursuing acareer in Emergency Medicine. It is

good to see the UnderrepresentedMember Mentoring Task Force specifi-cally developing focus groups toresearch minority students’ interest inEmergency Medicine and to develop amonograph to encourage underrepre-sented minority students to considerEmergency Medicine as a specialty.Through SAEM, there are efforts toincorporate Emergency Medicine intothe graduate curricula of the majority ofmedical schools.

We have increased SAEM’s visibilityto medical students through our web-site. Our goal is to support excellencein Emergency Medicine graduate med-ical education and recommend stan-dards for Emergency Medicine fellow-ship training and support the develop-ment of excellent fellowship trainingsites. Objectively, SAEM continues topromote quality resident education andpromotes activity which helps to meetprojected Emergency Medicine work-force needs in academic and communi-ty practice. SAEM has establishedresearch fellowships and institutionaltraining grants. Our goal is to supportthe development of new academicdepartments of Emergency Medicineand strengthen existing academicdepartments, divisions and sections. Agoal is also to recognize and supportacademic emergency departmentswhich incorporate education andresearch with the highest level of emer-gency care. An objective was to com-plete initial site visits and categorizationof 60 potential Level-1 EmergencyDepartments by 2004. Currently, onlyone site has been categorized but thereare others applying utilizing animproved application process. SAEMoffers a consultation service for devel-oping academic emergency depart-ments. An objective is to increase thenumber of academic EmergencyDepartments to 100 by 2004, or 75 per-cent of all American medical schools.Our goals include promoting nationaladvocacy for universal access to emer-gency care, the financing of teachinghospital Emergency Departments, andquality health care for all patients.Through the efforts of our NationalAffairs Task Force, Public Health TaskForce and Board we have pursuedthese goals vigorously. A goal is tomaintain and improve the quality, influ-ence and circulation of AcademicEmergency Medicine, SAEM’s peerreviewed journal established in 1994.

AEM is a high quality journal with an ISIcitation impact factor of 1.75 as of 1999,a significant increase from the 1998 fac-tor of 1.04 and a notable achievementfor such a young journal. The goal is tomaintain the quality of the annual meet-ing through continued innovation, and todevelop other SAEM meetings thatadvance the society’s mission inclusiveof regional meetings. Objectively,SAEM would increase the number ofscientific presentations that result inpublication in peer-reviewed journals,and increase the number of submis-sions to the annual meeting from fund-ed studies as well as encourage theparticipation of all Emergency Medicineprograms in SAEM regional meetings.A goal is to improve SAEM’s leadershipdevelopment to ensure a diverse groupof future leaders. Through efforts of theUnderrepresented Member MentoringTask Force’s we believe some ofSAEM’s future leaders will evolve.Further goals include development andenhancement of SAEM’s communica-tions, procedures and staff, and developfinancial resources, to provide ongoingfunding support for research and facultydevelopment. A major objective writtenin our 5-year plan is to develop a $5 mil-lion SAEM endowment to fund tenscholarly awards annually. The SAEMResearch Fund endowment has notreached $5 million yet. A major goal inprojecting SAEM 2010, realistically,would be to achieve a $10 millionendowment by that time to support theannual research fellowship, institutionaltraining grants, and sabbaticals. It isvery important to consider our commu-nications modalities by 2010. By 2010,the current newsletter potentially willbecome obsolete. Current and newelectronic means of communicationswill become more prominent.Membership growth has been levelingand will be very much dependent uponfurther development of academicdepartments and residency programs.SAEM staff growth will likely be neces-sary considering the need for improvedpublic relations, national advocacyactivities, communications with themembership, coordination of meetings,and journal activities. It’s my estimationthat the current staff is tremendouslyover-loaded with tons of work includingtimely production of newsletters andvarious other communications with themembership. Real estate acquisitionmay or may not be a concern by 2010.


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President’s Message (Continued)However, planning should take placestarting with a reevaluation of currentheadquarters including projections forcontinued maintenance, renovation andestimation of equity by 2010.

Of note, the Association of AcademicChairs of Emergency Medicine hasbeen tracking the number of NIH princi-pal investigator awardees forEmergency Medicine. EmergencyMedicine has not been routinely trackedby NIH in the past. SAEM should lookfuturistically at where our organizationshould be with the number of fundedgrants, clinician investigator activity, etc.SAEM should look at the MD/PHD pro-grams at medical schools and considerthe possibility of Emergency Medicineresearch grants geared towards thesestudents.

Regional meetings have grown innumbers and are doing well. There isno indication that significant furthergrowth over the current number of 5regional meetings will take placebetween now and 2010. The AnnualMeeting has been doing well. However,because the membership will likely notgrow tremendously there will probablynot be a large increase in number ofattendees or abstracts over the next 10years. The Annual Meeting and benefitsoffered by SAEM will need to be contin-uously enhanced for members at all lev-els including junior and senior level. It’sextremely important that our seniormembers and previous and current

leaders put forth the greatest effort pos-sible to advance SAEM through allareas of education, research, meetingsand development.

Opportunities for increasing interestin Emergency Medicine research couldbe made more available to medical stu-dents, nurses, paramedics, EMTs andother paraprofessionals. SAEM couldpromote a membership category to thelarge contingency of EMT/paramedicswho are interested in education andresearch. The opening of membershipto other categories has the potential offostering SAEM’s mission of improvedpatient care through advances inresearch and education as well asenhancing academic relationships witha larger segment of the EmergencyMedicine community.

With input from the Board, a surveytool was developed with the goal ofquerying other Council of AcademicSociety member organizations. TonyMazzaschi, Director of CAS Affairs,reviewed the survey tool and offeredsuggestions for revision before distribu-tion. The survey was distributed to otherCAS organizations in late November2001.

The idea is to learn from the otherCAS organizations’ missions, operatingbudgets, modes of communication,products, meeting formats, foundations,endowment funds, staff structure, head-quarters, advocacy activities and impor-tant services that the organizations pro-

vide. Information gleaned from the sur-vey will be summarized and shared withthe Board and the SAEM membershiparound March 2002. The SAEM Boardwill hold a long range planning meetingMarch 3, 2002. At that time, we willreview strategic planning for the SAEMResearch Fund, review environmentalstudies already done by others, consid-er areas of research emphasized byNIH etc. For the Board long-range plan-ning meeting in March, we have inviteda University Director of Corporate andFoundation Relations to provide us aninsight into the utility of a developmentofficer, fundraising and gift opportunitiesfor the SAEM Research Fund.

I expect that as the Board analyzesall information available to us we willcreate a list of projections for 2010 withthe idea of developing a working docu-ment in progress. I believe it will be thetemplate to develop the next 5-year planwhich will replace the current one whichends 2004. I request that you as anSAEM member share your thoughtsand visions for the future with me andthe Board. You can e-mail your com-ments to [email protected]. Wishing allSAEM members a wonderful NewYear!Reference

1. Cohen JJ. Learning to care for aHealthier Tomorrow. AAMC president’saddress presented at the plenary ses-sion of the 106th annual meeting,Washington, DC, Oct 27 – Nov 2, 1998.

Faculty Development Conference:Navigating the Academic Waters

March 2-4, 2002 – Washington, DCFaculty development continues to be one of the most carefully

scrutinized areas by the RRC-EM. Due to the relative growth ofour specialty, coupled with rapid growth of residency programsover the past 10 years, many younger faculty struggle to developneeded personal, management, teaching, and research skillsrequired for successful career advancement. CORD and AACEMhave conjointly developed a seminar entitled: “Navigating theAcademic Waters: Tools for Emergency medicine”. This confer-ence was first held in November 1996 and received high praisefrom attendees. The conference is designed specifically for theunique needs of junior Emergency Medicine faculty and willaddress essential elements necessary for success in an academ-ic environment including research development, grants, presenta-tions skills, resident evaluation, mentoring and clinical teaching,as well as time and personal management. This course nicelyaugments the ongoing efforts made by SAEM in the area of fac-ulty development. Young faculty or senior residents interested inan academic career should contact the CORD/AACEM office at517-485-5484 or the CORD web site at www.cordem.org.Registration is limited to 125 people, so call today!

Password Required to ReceiveAEM Online

SAEM members must now use a password to accesstheir online subscription to Academic EmergencyMedicine. All SAEM members are entitled to receive afree subscription of both the print copy and online ver-sion of AEM.

To activate your subscription go to the website:www.aemj.org, Click on the subscriptions button. Clickon the link “activate your member subscription.” Enteryour membership number (which is printed above yourname on the mailing label of this Newsletter) and clickthe submit button. You will then be asked to select auser name and password. If you need assistance ordo not have a member number, send an email [email protected] or call 517-485-5484.

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2002-2003 SAEM Committee/Task Force Interest Form Deadline: February 1, 2002

Members interested in serving on an SAEM committee or task force in 2002-2003 should submit this form,along with a current curriculum vitae and a cover letter describing relevant experience or other qualifications,

and likely contribution to the committee or task force. Completed forms submitted as e-mail attachments to [email protected] preferred, however mail and fax copies are also acceptable. Members are encouraged to review the following materi-als, available on the home page at www.saem.org or upon request from the SAEM office:

1. Committee/task force orientation guidelines that detail the role and structure of SAEM's committees and task forces.2. Current 2001-2002 committee/task force objectives.3. SAEM mission and vision statement, and SAEM's five-year goals and objectives.4. The article in the November/December Newsletter by Dr. Lewis, the current SAEM President-elect, regarding the com-

mittee/task force member selection process.

The following guidelines should be noted:1. The completed interest form, CV, and letter must be received by February 1, 2002.2. SAEM members, even if currently serving on a committee or task force, must submit a complete application to be con-

sidered for appointment or reappointment.3. Due to the relatively small number of committees and task forces, preference will be given to those whose applications

are thoughtful and focused.4. Committee and task force appointments and reappointments will be made by the President-elect by April 15, 2002. The

term of appointment is May 2002 to May 2003.5. Committee and task force members are expected to attend all meetings and actively participate in the committee/task

force activities. All committees and task forces meet at the SAEM Annual Meeting and many meet at the ACEP ScientificAssembly.

6. Individuals must be SAEM members to serve on a committee or task force.7. In general, one resident will be appointed to each committee and task force.

1. Which description best characterizes you?❒ EM resident, will complete residency in 20____.❒ Faculty member without previous SAEM committee or task force experience.❒ Faculty member with previous SAEM committee or task force experience.❒ Other (e.g. fellow):_________________

2. Is there a particular committee or task force in which you are interested? ❒ Yes ❒ NoIf so, which one(s): ______________________________________________________________________________

3. Is there a particular objective on which you are interested in working? ❒ Yes ❒ NoIf so, which one(s): ______________________________________________________________________________

4. What specific objectives or tasks do you think SAEM should pursue in the coming year?

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

5. Have you previously served on an SAEM committee or task force? ❒ Yes ❒ NoIf yes, list name of committee/task force and time period served:

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Name: ____________________________________________________________________________________________

Institution: ________________________________________________________________________________________

E-mail address: ____________________________________________________________________________________

Fax number: ______________________________________________________________________________________

Return to SAEM at 901 N. Washington Ave., Lansing, MI 48906, fax (517) 485-0801, or e-mail at [email protected]

SAEM

27

Choosing Members for 2002-2003 Committees and Task Forces: The Selection Process and How to Apply

Roger J. Lewis, MD, PhDSAEM President-electHarbor-UCLA Medical Center

In this issue of the SAEM Newsletter,a Committee Interest Form is included,so that all SAEM members may applyfor positions on SAEM committees.SAEM Committees are the "engine"which drives the organization. It isthrough the work of these committeesthat the mission of SAEM is advanced,the quality of our Annual Meeting main-tained and improved, and in which manyof the new ideas which strengthen ourorganization are developed and nur-tured.

Being appointed to an SAEM com-mittee is both an opportunity and a com-mitment. It is an opportunity to work toimprove the world of academic emer-gency medicine and to influence thedirection of the Society as a whole.Because there are frequently moremembers who wish to serve on SAEMcommittees than available committeepositions, it is expected that each mem-ber applying for a position is prepared tomake a significant commitment towardscompleting the work of the committee.One should only apply to become amember of an SAEM committee if youare willing and able to commit substan-tial time and energy.

It is important that potential commit-tee members be aware that the goalsand objectives of each committee arenot set by the committees themselves,but are guided by the five-year goalsand objectives of the Society anddefined by the Board of Directors. Thus,committee members must be prepared

to put their efforts towards the comple-tion of predefined goals and objectives.As outlined below, however, there is sig-nificant opportunity to influence thegoals and objectives of the committeesthrough feedback to each committeechair or to the Board of Directors direct-ly. The SAEM Board of Directors setsthe Goals and Objectives for each com-mittee and task force to help ensure acoordinated set of activities and toreduce duplicative efforts.

How are new Committee membersselected? First, each committee chair isasked to evaluate the performance ofeach current committee member.Committee members are evaluated interms of their productivity, work effort,responsiveness to requests, and overallcontribution to the function of the com-mittee. Approximately one-third of eachcommittee’s membership is rotated offeach year, based on both the chair’sevaluation of each member’s perform-ance, and based on the number of yearseach member has served on the com-mittee. This rotation is extremely impor-tant to ensure that as many SAEMmembers as possible have an opportu-nity to participate in the Society’s efforts.

All prospective committee members,whether currently on an SAEM commit-tee or with no prior experience, arerequired to submit a Committee InterestForm in order to be considered for newappointment or reappointment. TheCommittee Interest Form should beaccompanied both by a current curricu-lum vitae, as well as a narrative state-ment outlining the applicant’s motiva-tions for joining the committee, ideas

regarding areas in which they may con-tribute to the committee, and any otherinformation the applicant deems rele-vant. In evaluating these applications,the President-elect looks for evidence ofenthusiasm, focus, realism, new ideas,and commitment. Applications are gen-erally much stronger if they demonstratean understanding of SAEM’s mission,the five-year plan for the organization,and the current year’s goals and objec-tives for the individual committee (thisinformation can be found at the SAEMwebsite at www.saem.org). Please beaware that one-half or more of the goalsand objectives for each committee arerepeated each year. For example, onecan anticipate that an objective for theProgram Committee will always be tocoordinate the Annual Meeting, to selectabstracts for oral and poster presenta-tion, and to select didactic presenta-tions.

Among some SAEM members thereis an unfortunate perception that beingappointed to an SAEM committeerequires being a member of some innercircle. On the contrary, each year thePresident-elect makes a concertedeffort to appoint members who have notpreviously had an opportunity to serve,as part of an ongoing effort to developnew leadership talent in the Society.Because the President-elect cannotknow all members equally well, theinformation provided in the narrativestatement and curriculum vitae isweighted heavily in the selectionprocess. This helps to ensure fairness,opportunity, and a well-balanced com-mittee and task force membership.

Newsletter Submissions WelcomedDavid C. Cone, MDEditor, SAEM NewsletterYale University

SAEM invites submissions to the Newsletter pertaining toacademic emergency medicine I the following areas: 1) clinicalpractice; 2) education of EM residents, off-service residents,medical students, and fellows; 3) faculty development; 4) politicsand economics as they pertain to the academic environment; 5)general announcements and notices; and 6) other pertinent top-ics. Materials should be submitted electronically, preferably bye-mail to [email protected]. Be sure to include the names andaffiliations of authors and a means of contact. All submissionsare subject to review and editing. Queries can be sent to theSAEM office or directly to the Editor at [email protected].

Residency Vacancy ServiceThe SAEM Residency Vacancy Service wasestablished more than ten years ago to assistresidency programs and prospective emergencymedicine residents. The Residency Vacancy Serviceis posted on the SAEM web site at www.saem.org.Residency programs are invited to list theirunexpected vacancies or additional openings bycontacting SAEM. SAEM monitors and updates thelistings. Prospective emergency medicine residentsare invited to review these listings and contact theresidency programs to obtain further information.Listings are deleted only when the residency programinforms SAEM that the position(s) are filled.

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FACULTY POSITIONSALBANY MEDICAL COLLEGE: Emergency Medical Services Fellowshipsponsored by the Department of Emergency Medicine. Hands-on experiencein EMS practice and management with both ground and air medical agencies.Medical student, resident and out-of-hospital provider education isemphasized, as is research. Motivated BC/BE emergency physicians interestedshould send CV to: Deb Funk, MD, EMS Fellowship Director, Albany MedicalCollege, MC-179, 47 New Scotland Ave, Albany, NY 12208 or call (518) 262-8800. Affirmative Action/Equal Opportunity Employer.

INDIANA UNIVERSITY SCHOOL OF MEDICINE: Department of EmergencyMedicine is recruiting clinician teachers to provide care at the public hospitalemergency department located on the medical center campus. WishardHospital is a Level I Trauma Center, base for one of the country’s busiest pre-hospital emergency transport services, and regional burn center. The EDrecorded 105,000 visits in 2000. Wishard complements Methodist inproviding clinical experiences for IUSM EM residents. Enthusiasm for medicaleducation, facilitation of clinical research, and excitement for patient care ina busy public hospital ED are expectations. Residency training, certificationin EM are required. Rank and tenure status are dependent upon interests andqualifications. Apply to Jamie Jones MD ([email protected]) or RollyMcGrath, MD ([email protected]), FAX (317) 656-4216. IU is an EEO/AAEmployer, M/F/D.

LEHIGH VALLEY HOSPITAL: We’re adding two positions to assure triplecoverage – one available now and one this summer. Seeking BC/BE EM-trained physicians to join cohesive faculty of 30 BC physicians evaluating45,000 patients at the main site of 700-bed Lehigh Valley Hospital (Total of100,000 visits at all three sites.) LVH is academic, tertiary hospital with EMResidency, Level I trauma, 9-bed Burn Center. Member of the prestigiousCouncil of Teaching Hospitals (COTH). Faculty appointment at PennState/Hershey. Opportunity for resident teaching and clinical research.Allentown has great public schools, safe neighborhoods, moderate cost ofliving, 10 colleges and universities, and is 60 miles North of Philadelphia and80 miles West of Manhattan. Email CV c/o Michael Weinstock MD, Chair EM,to [email protected] Fax (610) 402-7014. Phone (610) 402-7008.

OHIO STATE UNIVERSITY: Assistant/Associate or Full Professor. Establishedresidency training program. Level 1 Trauma center. Nationally recognizedresearch program. Clinical opportunities at OSU Medical Center and affiliatedhospitals. Send curriculum vitae to: Douglas A. Rund, MD, Professor andChairman, Department of Emergency Medicine, The Ohio State University,016 Health Sciences Library, 376 W. 10th Avenue, Columbus OH 43210 orcall (614) 293-8176. Affirmative Action/Equal Opportunity Employer.

OREGON: The Oregon Health Sciences University Department ofEmergency Medicine is conducting an ongoing recruitment of talented entry-level clinical faculty members at the assistant professor level. Preference isgiven to those with fellowship training, experience in collaborative clinicalresearch, and writing skills, Please submit a letter of interest, CV, and thenames and phone numbers of three references to: Jerris Hedges, MD, MS,Professor & Chair, OHSU Department of Emergency Medicine, 3181 SWSam. Jackson Park Road, UHN-52, Portland OR 97201-3098.

UNIVERSITY OF CONNECTICUT/HARTFORD HOSPITAL: One yearpositions in EMS and Research/Administration; available July 2002. Multi-hospital program with 100,000 ED visits, 30 EM residents, active air/groundEMS service. MPH opportunity. Inquiries: Robert D. Powers MD MPH,Professor & Chief of EM. email: [email protected].

UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL: 2 openings foreither full-time academically qualified Emergency Medicine, tenure-trackphysicians or for full-time clinical track physicians at the Clinical Instructor orClinical Assistant Professor level. Successful tenure-track candidates will beBoard Certified/Board Prepared in Emergency Medicine with an interest inclinical cardiology or neurosciences research. Clinical track faculty areexpected to do clinical work only. UNC Hospitals is a 665-bed Level I TraumaCenter. The Emergency Department sees upward of 40,000 high acuitypatients per year, is active in regional EMS, ACLS/ATLS/BTLS education andhas an aeromedical service. Send CV to Edward Jackem, MBA, Department ofEmergency Medicine, CB #7594, Chapel Hill, NC 27599-7594. (919) 966-9500. FAX (919) 966-3049. UNC is an Equal Opportunity/ADA Employer.Women and minorities are encouraged to apply.

VANDERBILT UNIVERSITY: Research Director - The Department ofEmergency Medicine at Vanderbilt University is seeking a research-orientedfaculty member for a tenure track position. This position will be customizedto meet a junior or senior level faculty members training and experience. Thisexciting position is based in the Department of Emergency Medicine incollaboration with The Vanderbilt Center for Health Services Research. Theindividual to be recruited will have completed training in an Emergency

University of CincinnatiMedical Center

Open Rank: The University of Cincinnati Departmentof Emergency Medicine has a full-time academicposition available with research, teaching, and patientcare responsibilities. Candidate must be residencytrained in Emergency Medicine with boardcertification/preparation. Salary, rank, and trackcommensurate with accomplishments andexperience. The University of Cincinnati Departmentof Emergency Medicine established the first residencytraining program in Emergency Medicine in 1970.The Center for Emergency Care evaluates and treats76,000 patients per year and has 40 residents involvedin a four-year curriculum. Our department has a longhistory of academic productivity, with outstandinginstitutional support.

Please send Curriculum Vitae to:

W. Brian Gibler, MDChairman, Department of Emergency MedicineUniversity of Cincinnati Medical Center231 Bethesda AvenueCincinnati, OH 45267-0769

ACADEMIC EMERGENCY MEDICINE

The University of Washington seeks a physicianto join its faculty in the Emergency MedicineService in the Department of Medicine at theUniversity of Washington Medical Center. Thisfull-time position requires direct patient care,teaching and supervision of medical studentsand housestaff, and the expectation forengagement in scholarly activities. The applicantmust be board certified in emergency medicine.The successful candidate will be appointed asfull-time faculty member; at the rank of assistantor associate professor in the clinician/teacher(patient care/teaching emphasis) pathway, orphysician/scientist (research emphasis)pathway. Applicants should submit a curriculumvitae and a statement of career goals to: TerryMengert, M.D., Emergency Medicine Service,University of Washington Medical Center, Box356123, Seattle, WA 98195-6123. The Universityof Washington is building a culturally diversefaculty and strongly encourages applicationsfrom female and minority candidates. TheUniversity is an Equal Opportunity/AffirmativeAction employer. Deadline for inquiries isJanuary 31, 2002.

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DEPARTMENT OF EMERGENCY MEDICINEMASSACHUSETTS GENERAL HOSPITAL

A Teaching Affiliate of HarvardMedical School

Academic Emergency Physician Positions

• Opportunities exist for established academic emergency physicianswith a proven track record in clinical or laboratory research and acommitment to excellent clinical care and teaching.

• Academic appointment is at Harvard Medical School.• MGH is consistently rated among the top 10 in the annual US News and

World Report Survey.• In the year 2000 we had a volume of over 70,000 ED visits.• We are a Level I Trauma Center for Adults and Pediatrics as well as

Burns.• We are an equal partner in the four-year BWH/HMG Harvard Affiliated

Emergency Medicine Residency Program.• The successful candidate will join 17 full-time academic emergency

physicians in an active academic department with a rapidly developingresearch program.

REQUIREMENTS:• Completion of a four-year residency-training program in emergency

medicine, or three-year program, followed by a fellowship or at least oneyear’s experience.

• Established track record in or strong commitment to academicemergency medicine.

Inquiries should be accompanied by a curriculum vitae and may beaddressed to:

David F.M. Brown, MD, FACEP, Assoc. ChiefDepartment of Emergency MedicineMassachusetts General Hospital55 Fruit StreetBoston, Massachusetts 02114e-mail: [email protected]

Massachusetts General Hospital is an equal opportunity employer.

UNIVERSITY OF FLORIDAThe College of Medicine is seeking to hire one physician atthe rank of Clinical Assistant Professor/Clinical AssociateProfessor in the Department of Emergency Medicine. Thisteaching hospital emphasizes active involvement withEmergency Medicine residents and medical students. Theposition could advance to tenure accruing depending uponqualifications and level of experience. Qualfied applicantswill be Board Certified in Emergency Medicine, maturewith an academic track record, significant teachingexperience and superb administrative/fiscal acumen a plus.Faculty will provide clinical guidance and supervison oftreatment delivered in the ED. A progressive, democratic,superb, 10-person faculty group of team players withemphasis on quality emergency care with dedicatedcustomer service. Shands at UF is the hub of a multi-hospital network. Emergency Medicine medically directscounty EMS and hospital transport including theShandsCare helicopter. Great compensation, Great benefitspackage, Great City! Application deadline: 12/30/01;Anticipated start date: 06/01/02. Please send personalstatement, CV to Ahamed Idris, MD, Professor and SearchCommittee Chairperson, Department of EmergencyMedicine, University of Florida, 1600 SW Archer Road,P.O. Box 100186, Gainesville, FL 32610-0392. Women andminorities are encouraged to apply. University of Florida isan Affirmative Action Equal Opportunity Employer.

Medicine Residency Program. He or she should have a strong interest, orrecord, in an academic career and a desire to focus on outcomes research.Funding to complete an MPH (if desired) will be provided. This position willhave up to 80% protected time and start-up funding for up to 5 years.Secretarial, research nurse, and statistical support will be provided, along witha premium discretionary research package. Appointments will becommensurate with the individuals level of achievement. Excellent salaryand benefits in a great community. Please reply to Corey M. Slovis, M.D.,Chairman, Department of Emergency Medicine, Vanderbilt University, Room703, Oxford House, Nashville, TN 37232-4700, Email: [email protected].

WASHINGTON HOSPITAL CENTER (WHC) and GEORGETOWNUNIVERSITY HOSPITAL (GUH) in Washington, D.C. are seeking physiciansboard certified or residency trained in emergency medicine to join theirfaculty. Our Department of Emergency Medicine is both traditional andcutting edge: traditional in that we believe that the provision of medical careis a sacred trust; cutting edge in that we are committed to using the mostadvanced information technology to improve clinical care. We are seekingphysicians who share our common vision, who are willing to work hard, andwho want to be part of a very exciting and cohesive group committed topracticing at the leading edge of our specialty. WHC is the largest hospital inthe Washington, D.C. metropolitan area. It trains students and residents,operates three helicopters and a critical care ground transport service, isnationally acclaimed for its MedSTAR trauma program, and has one of thenation’s busiest interventional cardiology programs. The EmergencyDepartment has more than 62,000 annual visits and 16,000 annual hospitaladmissions. GUH is a renowned academic institution in Washington, DC. Itis the site of one of the oldest emergency medicine residency trainingprograms in the country. The Emergency Department treats nearly 30,000adult and pediatric patients. Contact Mark Smith, MD, FACEP, Chairman ofEmergency Medicine, at (202) 877-0808, fax (202) 877-2468 or write to himat Washington Hospital Center, Department of Emergency Medicine, 110Irving Street, NW, Washington, D.C. 20010-2975.

FACULTY POSITION

The Division of Emergency Medicine atDuke University Medical Center is working

to develop an Emergency MedicineResidency Program. We are currently seeking

full-time academic faculty members. Thesepositions offer a variety of opportunities for

clinical practice, teaching, and research.Residency training and BC in EM required.Duke University Medical Center EmergencyDepartment is a Level I Trauma Center inDurham, North Carolina, with an annual

volume of 65,000 patient visits. Competitivesalary and benefits. Faculty at all academic

levels are invited to apply.

Please contact:

Kathleen J. Clem, MD, FACEPChief, Division of Emergency Medicine

DUMC 3096, Durham, NC 27710email: [email protected]

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University of CincinnatiMedical Center

ANNOUNCING

The University of Cincinnati Department ofEmergency Medicine has established a second Endowed

Chair in Emergency Medicine. We are seeking anestablished clinician scientist to hold the Endowed

DISTINGUISHED CHAIR FOR CLINICALRESEARCH IN EMERGENCY MEDICINE

The University of Cincinnati Department of Emergency Medicineestablished the first Residency Training Program in EmergencyMedicine in 1970. We have a long history of productive research withspecial emphasis on Cardiovascular, Neurovascular,Toxicology/HBO, and Outcomes investigation. This Endowed Chairoffers a special opportunity for an individual to pursue a leadershipposition in Emergency Medicine.

Individuals interested in this opportunity are encouraged to contact:W. Brian Gibler, MDRichard C. Levy Professor of Emergency MedicineChairman, Department of Emergency MedicineUniversity of Cincinnati College of Medicine231 Albert Sabin WayCincinnati, OH 45267-0769513/558-8086 FAX: 513/558-4599e-mail: [email protected]

Academic Emergency MedicineThe Department of Emergency Medicine, Wright State University

School of Medicine seeks a faculty member at the Instructor, Assistantor Associate Professor level. Faculty rank and salary arecommensurate with the candidate’s professional qualifications andSchool of Medicine standards. Faculty activities include medicaleducation at all levels, curriculum coordination, administration andpatient care. An interest and ability in clinical and classroomeducation are preferred. Requirements for appointees include:Instructor, Board prepared; Assistant, Board Certified; Associate, boardCertified and 5 years Emergency Medicine experience. All must begraduates of Emergency Medicine Residency and eligible for Ohiolicense. Applicants should send curriculum vitae and names of threereferences to:

Glenn C. Hamilton, MD, MSMDepartment of Emergency Medicine

3525 Southern Blvd., Kettering, OH 45429Phone: (937) 296-7839 • Fax: (937) 296-4287

email: [email protected]

Consideration of applications begins September 15, 2001 and willcontinue until the positions are filled. Wright State University is an

AAEO Employer.

FACULTY POSITIONS

Department of Emergency MedicineTufts University School of Medicine

Baystate Medical CenterSpringfield, MA 01199

www.baystatehealth.com

Emergency Medicine Researcher: Seeking an emergency medicine researcher withexperience in clinical research and grant writing. The position includes significant pro-tected time; minimal clinical and administrative responsibilities; competitive salary(AAMC Standards) not based on grant support; departmental research staff includinga clinical nurse researcher, a data manager, a team of EM research faculty; office spaceand secretarial support; an academic appointment with Tufts University School ofMedicine consistent with experience and publications.

Pediatric Emergency Medicine: Seeking BC/BE physician in Pediatric EmergencyMedicine and Emergency Medicine to join a regional trauma center with a fullyaccredited Emergency Medicine Residency Training Program and a Children’sHospital. Opportunities include a full unencumbered medical school academicappointment, participation in a Pediatric Emergency Medicine fellowship being devel-oped, and an active clinical research program. You will serve as an attending physicianin the Pediatric and Main ED.

Baystate Medical Center is a Level 1 Trauma Center, 500-bed hospital with an annualED census of 98,000 in Western Massachusetts. Baystate Medical Center has a PGY1-3 emergency medicine residency with 12 residents per year and was recently namedone of the top 15 major teaching hospitals in the United Sates for clinical excellenceand efficient delivery of care (HCIA and The Health Network).

Springfield is located in the beautiful Connecticut River valley at the foothills of theBerkshires with convenient access to coastal New England, Vermont and metropolitanBoston and New York. The area also supports a rich network of academic institutionsincluding the University of Massachusetts and Amherst, Smith, Hampshire and MountHolyoke Colleges.

Please send your letter of interest with curriculum vitae to:

Phil Henneman, MD, Professor and ChairDepartment of Emergency MedicineTufts University School of Medicine

c/o Don Rainwater, Baystate Medical Center759 Chestnut Street, S-1578, Springfield, MA 01199

Tel: (800) 767-6612, Fax: (413) 794-5059E-mail: [email protected]

Baystate Health System is an Equal Opportunity Employer

Academic Emergency Medicine Faculty PositionPeoria, Illinois

Due to expanding faculty coverage, OSF Saint Francis MedicalCenter is seeking full time Emergency Medicine Residency Trainedor Board Certified Emergency physicians to join its 22 memberEmergency Medicine Faculty at the University of Illinois Collegeof Medicine at Peoria. OSF Saint Francis Medical Center isa large community teaching hospital, a major affiliate of theUniversity of Illinois College of Medicine at Peoria with over 82,000total system visits including 61,000 Emergency Department visits. Theinstitution is a Level I Trauma Center, Base Station and resourcehospital for EMS and has the busiest aero-medical program, LifeFlight (1400 flights annually) in Illinois. We have a total of 24 residentsin a 1-2-3 program. This is an exceptional opportunity to be part of anextremely experienced, progressive academic faculty with a top endcompetitive employee compensation and benefits package.Academic appointment available at the University of IllinoisCollege of Medicine at Peoria. Peoria is located in CentralIllinois in a wonderful, family oriented community. Come help uscarry out our mission in providing compassionate, state of the artpatient care in a friendly Midwestern environment with abundantrecreational opportunities.For more information contact George Z. Hevesy, MD, FACEP, Director,Emergency Medical Services, Chairman, Department of EmergencyMedicine OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue,Peoria, Illinois 61637 or call 309-655-2553, email [email protected]

UIC The University of IllinoisCollege of Medicine at Peoria

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UNIVERSITY OF FLORIDACollege of Medicine, Department of Emergency Medicine isoffering a 2-year fellowship in basic science and clinicalresearch. We are seeking a Board Eligible/Board Certifiedphysician, residency trained in Emergency Medicine. Weoffer courses in an interdisciplinary program in BiomedicalSciences and M.S. in clinical investigation upon successfulcompletion. Our Department has active, cutting-edgemultidisciplinary research programs in asthma, ventilation,cardiopulmonary resuscitation, stroke, biomarkers andtreatment for oxidant injury, and traumatic brain injury.Nationally recognized scientists head our researchprograms. We collaborate with the University of FloridaMcKnight Brain Institute, a nationally recognized resourceand also have international collaborative clinical projects.We have a fully equipped laboratory and resources forclinical research. Fellows have the opportunity to work withsmall and large animal models. We offer 80% protected timefor research, competitive compensation and benefits, a greatworking environment, and a great city! Applicationdeadline: February 20, 2002; Anticipated start date: July 1,20002. Please send a personal statement, Curriculum Vita toAhamed Idris, MD, Professor and Director of EmergencyMedicine Research, Department of Emergency Medicine,University of Florida, P.O. Box 100186, Gainesville, FL32610-0186. Women and minorities are stronglyencouraged to apply.

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Newsletter AdvertisingThe SAEM Newsletter is mailed every other month to the5,500 members of SAEM. Advertising is limited to fel-lowship and academic faculty positions. All ads areposted on the SAEM web site at no additional charge.

Deadline for receipt: March 1 (March/April issue), May25 (May/June issue), June 15 (July/Aug issue), August 1(Sept/Oct issue), and October 15 (Nov/Dec issue). Adsreceived after the deadline can often be inserted on aspace available basis.

Advertising Rates: Classified Ad (100 words or less)Contact in ad is SAEM member ................$100Contact in ad non-SAEM member ............$125

1/4 - Page Ad (camera ready)3.5" wide x 4.75" high ..........................$300

To place an advertisement, e-mail, fax or mail the ad,along with contact person for future correspondence,telephone and fax numbers, billing address, ad size, andNewsletter issues in which the ad is to appear to: JenniferMastrovito at [email protected], via fax at (517) 485-0801 or mail to 901 N. Washington Avenue, Lansing, MI48906. For more information or questions, call (517)485-5484 or [email protected].

All ads posted on the SAEM web site at no additional charge.

FULL-TIME FACULTYASSISTANT ORASSOCIATEPROFESSOR LEVEL

The Section of Emergency Medicine at Yale University Schoolof Medicine is recruiting full time faculty members at theAssistant or Associate Professor level. Our environment offers:• Academic growth with generous protected time to pursue

research and scholarly activities• All clinical practice at Yale-New Haven Hospital, a Level I

Trauma Center with over 80,000 ED visits per year• An accredited Emergency Medicine Residency program

with 40 residents (PGY-1-4)• An EMS fellowship• Opportunities for collaboration with other faculty in the

School of Medicine, School of Public Health and otherprofessional schools in the University

Applicants should be residency trained and boardcertified/qualified in Emergency Medicine. Salary and academicrank is commensurate with experience and accomplishments.

Send letter of interest and Curriculum Vitae to:John A. Schriver, MD

Chief, Section of Emergency MedicineDepartment of Surgery

Section of Emergency Medicine464 Congress Avenue, Suite #260

New Haven, CT 06519-1315Yale University and Yale-New Haven Hospital are affirmative action,equal opportunity employers and women and members of minority groupsare encouraged to apply.

UNIVERSITY OFOTTAWA

Clinical ResearchFaculty Position

The Division of Emergency Medicine and the OttawaHealth Research Institute seek an experienced clinicalinvestigator at the Associate or Full Professor level.Applicants must possess an MSc in Epidemiology orMPH or equivalent, and must have a well-establishedrecord of clinical research in emergency medicine. Thesuccessful candidate will participate in a world-classresearch program in the new Centre of Research inEmergency Medicine.

For further information contact:

Ian G. Stiell, MD, MSc, FRCPCOHRI Chair of Research in Emergency Medicine

Ottawa Health Research Institute1053 Carling Avenue, Room F650

Ottawa, Ontario. CANADA K1Y 4E9Telephone: (613) 798-5555, ext. 18688

E-mail: [email protected]://www.ohri.ca/profiles/stiell.asp

33

Emergency Medicine FoundationResearch Grant Program Overview

All funding periods are July 1, 2002-June 30, 2003 unless otherwise noted. Contact EMF at 800-798-1822 or www.acep.org.

EMF Career Development GrantDescription: A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needsseed money or release time to begin a promising research project.Deadline: January 11, 2002 Notification: March 20, 2002

EMF Creativity and Innovation in Emergency Medicine GrantDescription: A maximum of $5,000 to support small pilot projects that are new and innovative. It is intended to provide releasetime or provide equipment and supplies for new investigators or for experienced investigators who have a novel idea.Deadline: December 12, 2001 Notification: March 20, 2002

EMF Research Fellowship GrantDescription: A maximum of $35,000 to emergency medicine residency graduates who will spend another year acquiring spe-cific basic or clinical research skills and further didactic training in research methodology.Deadline: January 11, 2002 Notification: March 20, 2002

EMF Resident Research GrantDescription: A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level.Deadline: December 12, 2001 Notification: March 20, 2002

Riggs Family/EMF Health Policy Research GrantDescription: Between $25,000 and $50,000 for research projects in health policy or health services research topics.Applicants may apply for up to $50,000 of the funds, for a one- or two-year period. The grants are awarded to researchers in thehealth policy or health services area, who have the experience to conduct research on critical health policy issues in emergencymedicine.Deadline: December 5, 2001 Notification: March 20, 2002

EMF/FERNE Neurological Emergencies GrantDescription: This grant program is sponsored by EMF and the Foundation for Education and Research in NeurologicalEmergencies (FERNE). The goal of this directed grant program is to fund research based towards acute disorders of the neuro-logical system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 willbe awarded in this program annually.Deadline: January 16, 2001 Notification: March 20, 2002

EMF/SAEM Medical Student Research GrantDescription: This grant program is sponsored by EMF and SAEM. A maximum of $2,400 over 3 months for a medical studentto encourage research in emergency medicine.Deadline: January 18, 2002 Notification: March 20, 2002

EMF/SAEM Innovation in Medical Education ResearchDescription: This grant program is sponsored by EMF and SAEM. A maximum of $5,000 to support projects related to edu-cational techniques pertinent to emergency medicine training.Deadline: November 14, 2001 Notification: March 20, 2002

EMF Directed Research Cardiac Arrest Survival AwardDescription: This grant program is sponsored by the EMF and Wyeth-Ayerst. The goal of this directed grant program is to fundresearch proposals specifically targeting research that is designed to improve the outcome of patients who suffer cardiac arrest.Potential proposals can include basic science, translational or clinical science investigations. A maximum of $100,000 over 2 years(July 1, 2002-June 30, 2004) will be awarded in this program.Deadline: November 21, 2001 Notification: March 20, 2002

EMF/ENAF Team GrantDescription: A maximum of $10,000 to be used for physician and nurse researchers to combine their expertise in order todevelop, plan and implement clinical research in the specialty of emergency care.Deadline: January 11, 2002 Notification: March 20, 2002

EMF Established Investigator AwardDescription: A maximum of $50,000 to established researchers.Deadline: December 19, 2001 Notification: March 20, 2002

34

Call for AbstractsSAEM Western Regional

Research ForumSan Diego, CAApril 6-7, 2002

Keynote Speaker: Peter Rosen, MDLocation: The beautiful Holiday Inn on the BayConference Center overlooking San Diego HarborDeadline for abstract submission: January 15, 2002.On-line submission preferred via abstract submissionprocess for national SAEM Annual Meeting atwww.saem.org. However abstracts may also be submitted to: [email protected]. All regions invited tosubmit abstracts.Highlights include oral and poster presentations, smallgroup sessions where you can bring your research pro-posals to the experts, IRB issues, what to do if yourmanuscript is rejected, a medical version of theWeakest Link, and special EM resident and medicalstudent tracks.Come and enjoy the sun and surf in San Diego!Hosted by the University of California, San DiegoEmergency Medicine ResidencyFor more information contact Stephen R. Hayden, MD,at: [email protected]

Call for Abstracts5th Annual SAEM

Mid-Atlantic Regional Meeting

April 11 & 12, 2002First USA Riverfront Arts Center

Wilmington, DE

Keynote Speakers: Marcus Martin, MD, and CharlesPollack, Jr, MA, MD

Special presentation: Joseph Lex, Jr., MD Other highlights: oral paper and poster scientific presen-

tations, renowned speakers, convenient location.The deadline for abstract submission is February 1,

2002 via the SAEM online abstract submission form atwww.saem.org.

Hotel reservations can be made at the Sheraton SuitesHotel in Wilmington, DE and transportation will be provid-ed to the meeting site.

For information contact: Patty McGraw, RN, MS or BrianBurgess, MD, Department of Emergency Medicine,Christiana Care Health Services, 4755 Ogletown-StantonRoad, Room L877, Newark, DE 19718; phone: 302-733-4166; fax: 302-733-1625; e-mail: [email protected]. The deadline for conference registration isMarch 8, 2002.

SAEM

Call for AbstractsSoutheastern Regional SAEM Meeting

April 12-14, 2002Jacksonville, FL

The program committee is now accepting abstracts for oral and poster presentations. Abstracts may be submitted electron-ically via the SAEM web site at [email protected] or by email to [email protected] until January 8, 2002. Please usethe SAEM submission form http://www.saem.org/meetings/regabst.htm if submitting by email.

There will be oral and poster research presentations, round table discussions with leaders in Academic EmergencyMedicine, keynote presentations, and hands on educational sessions including:

- difficult airway management / alternative airway devices- resuscitation using an advanced patient simulator- emergency ultrasonography

All in a relaxed atmosphere in sight of the Atlantic Ocean!

Registration: medical students and residents are particularly encouraged to attend, and receive a discounted registrationfee of $50 (medical students) and $75 (residents). Registration for attending physicians is $110.

To register, contact: Ms. Everlena Owens • phone: (904) 244-4106 • fax: (904) 244-4508 • email [email protected]

Hotel: Rooms have been reserved at the host hotel, the Sea Turtle Inn http://www.seaturtle.com/ • phone (800) 874-6000 or(904) 249-7402, for $140 – $180 per night. Mention the SE SAEM conference to receive the discounted rates.

Other Activities: Spouses and children are welcome. The beach is the main attraction. Transportation will be provided forthose who would like to take a day trip to historic downtown St. Augustine on Saturday.

SAEM

35

Call for Abstracts6th Annual New England Regional SAEM Meeting

April 3, 2002Hoagland-Pincus Conference Center

Shrewsbury, Massachusetts

Keynote Speaker: Ian Stiell, MD, MSc, FRCPC

The Program Committee is now accepting abstracts for review for both oral and poster presentations at the New EnglandRegional SAEM Meeting. The meeting will take place April 3, 2002, 9:00 am-4:00 pm, at the Hoagland-Pincus ConferenceCenter in Shrewsbury, MA; www.umassmed.edu/conferencecenter/

The deadline for abstract submission is Tuesday, January 8, 2002 at 3:00 pm Eastern Time and will be strictly enforced.Only electronic submission via the SAEM online abstract submission form will be accepted. Go to www.saem.org for moreinformation. Acceptance notifications will be sent in late February 2002.

Send registration forms to: Kathleen Shea, Department of Emergency Medicine Research, 1BMC Place, Dowling 1S - Room#1332, Boston, MA 02118-2393; [email protected]

Registration fees: Faculty - $100; Resident/Nurses - $50; EMTs/Students - $25. Late fee after March 20: add $25. Checkspayable to Boston Emergency Physicians Fund.

SAEM

Call for NominationsSAEM Elected Positions

Deadline: February 1, 2002

Nominations are sought for the SAEM elections which will be held in the spring of 2002 via mail or electronic bal-lot. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to

SAEM, leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academicemergency medicine.

Interested members are encouraged to review the appropriate SAEM orientation guidelines (Board, Committee/Task Force orPresident-elect) to consider the responsibilities and expectations of an SAEM elected position. Orientation guidelines are availableat www.saem.org or from the SAEM office.

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more than onenominee for each position. Nominations may be submitted by the candidate or any SAEM member and should include the candi-date's CV and a cover letter describing the candidate's qualifications and previous SAEM activities. Nominations are sought for thefollowing positions:

President-elect: The President-elect serves one year as President-elect, one year as President, and one year as Past President.Candidates are usually members of the Board of Directors.Secretary/Treasurer: The Secretary/Treasurer serves a three-year term on the Board. Candidates should have a track record ofexcellent service and leadership on SAEM committees and task forces and are usually members of the Board.Board of Directors: Two members will be elected to three-year terms on the Board. Candidates should have a track record ofexcellent service and leadership on SAEM committees and task forces.Resident Board Member: The resident member is elected to a one-year term and is a full voting member of the Board. Candidatesmust be a resident during the entire term on the Board (May 2002-May 2003) and should demonstrate evidence of strong interestand commitment to academic emergency medicine. Nominations should include a letter of support from the candidate's residencydirector.Nominating Committee: One member will be elected to a two-year term. The Nominating Committee selects the recipients of theSAEM awards (Young Investigator, Academic Excellence, and Leadership) and develops the slate of nominees for the elected posi-tions. Candidates should have considerable experience and leadership on SAEM committees and task forces.Constitution and Bylaws Committee: One member will be elected to a three-year term, the final year as the chair of theCommittee. The Committee reviews the Constitution and Bylaws and makes recommendations to the Board for amendments to beconsidered by the membership. Candidates should have considerable experience and leadership on SAEM committees and taskforces.

SAEM

Board of DirectorsMarcus Martin, MDPresident

Roger Lewis, MD, PhDPresident-Elect

Donald Yealy,MDSecretary-Treasurer

Brian Zink, MDPast President

James Adams, MDFelix Ankel, MDCarey Chisholm, MDGlenn Hamilton, MDJudd Hollander, MDDebra Houry, MD, MPHSusan Stern, MD

EditorDavid Cone, [email protected]

Executive Director/Managing EditorMary Ann [email protected]

Advertising CoordinatorJennifer [email protected]

“to improve patient care byadvancing research andeducation in emergencymedicine”

The SAEM newsletter is published bimonthly by the Society for Academic EmergencyMedicine. The opinions expressed in this publication are those of the authors and donot necessarily reflect those of SAEM.

Society for AcademicEmergency Medicine901 N. Washington AvenueLansing, MI 48906-5137

PresortedStandard

U.S. PostageP A I D

Lansing, MIPermit No. 485NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

SAEM NEWSLETTER

Call for PhotographsDeadline for receipt: February 15, 2002

Original photographs are invited for presentation at the SAEM 2002 Annual Meeting in St. Louis. Photographsof patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data may besubmitted. Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to thepractice of emergency medicine or findings of unusual interest that have educational value. Acceptedsubmissions will be mounted by SAEM and presented in the "Clinical Pearls" session and/or the "VisualDiagnosis" medical student/resident contest.

No more than three different photos should be submitted for any one case. Submit one glossy photo (5 x 7, 8 x 10, 11 x 14, or16 x 20) or a digital copy in JPEG or TIFF format on a disk or by email attachment (resolution at least 640 x 480). Radiographsshould be submitted as glossy photos, not as x-rays. For EKG’s, send an original and a digital image. The back of each photoshould contain the contributor’s name, address, hospital or program, and an arrow indicating the top. Submissions should beshipped in an envelope with cardboard but should not be mounted.

Photo submissions must be accompanied by a case history written as an "unknown" in the following format:1. Chief complaint2. History of present illness3. Pertinent physical exam4. Pertinent laboratory data5. One or two questions asking the viewer to identify the diagnosis or pertinent finding.6. Answer(s) and brief discussion of the case, including an explanation of the findings in the photo.7. One to three bulleted take home points or "pearls"

The case history must be 250 words or less with at least one blank line between sections. The case history MUST be submittedas an email attachment to [email protected]. If accepted for display SAEM reserves the right to edit the submitted case history.

Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, thecase history, and appropriateness for public display. Contributors will be acknowledged and photos will be returned after themeeting.

Photographs must not appear in a refereed journal prior to the Annual Meeting. Patients should be appropriately masked. Writtenconsent is required for all submissions except for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc. Writtenconsent and release of responsibility, where necessary, must accompany submissions.

All submissions will be considered for publication in Academic Emergency Medicine. In addition, SAEM reserves the right topost selected images and case histories on the SAEM website for teaching purposes. Submitters will be acknowledged. SAEMwill retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

Send submissions to SAEM at 901 North Washington Avenue, Lansing, MI 48906 or [email protected].

SAEM

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January-February 2002

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